Presented  by 
Dale  Thurston,  D.  0. 


COLLEGE    OF    OSTEOPATHIC    PHYSICIANS 
AM)  SURGEONS  •    LOS  AXGELES,  CALIFORNIA 


Pig.   95. — Diagram   of  dorsal   muscles — 4th  layer.     Adapted   from  a  dia- 
gram   in    Cunningham's    Anatomy. 


PRINCIPLES  OF 
OSTEOPATHY 

/ 

By 
DAIN  L.  TASKER,  D.O.,  D.Sc.O. 


PROFESSOR  OF  THEORY  AND  PRACTICE  OF  OSTEOPATHY  AND  CLINICAL 

OSTEOPATHY  IN  THE  PACIFIC  COLLEGE 

OF  OSTEOPATHY. 

FELLOW  OF  THE  SOUTHERN  CALIFORNIA  ACADEMY  OF  SCIENCES. 

MEMBER    OF    THE    CALIFORNIA    STATE   BOARD    OF   OSTEOPATHIC 

EXAMINERS. 

MEMBER  OF  THE  AMERICAN  OSTBOPATHIC  ASSOCIATION. 


SECOND    EDITION 

REVISED  and  ENLARGED 
ILLUSTRATED 


Published  by 

BAUMGARDT  PUBLISHING  CO. 

Los  Angeles,  Cal. 

1905 


COPYRIGHTED   1903,   BY  THE  AUTHOR. 

DAIN  L.  TASKER.  D.O. 

LOS  ANGELES.    CALIFORNIA. 


- 

£.3 


PREFACE. 

This  book  on  the  Principles  of  Osteopathy  is  intended  as 
a  manual  for  the  use  of  students  and  practitioners.  There  has 
been  no  effort  on  the  part  of  the  author  to  do  more  than  give 
a  short,  terse  exposition  of  the  essential  facts  underlying  os- 
teopathy. Realizing  fully  the  great  effort  required  to  keep 
pace  with  the  rapid  progress  of  medicine  in  general  we  have 
tried  to  include  in  our  chapters  only  that  which  will  be  solid 
food  for  our  readers.  W!e  have  long  since  learned  that  the 
hurried  student  and  busy  practitioner  have  no  time  to  read 
long  dessertations  on  any  subject.  Time  is  an  essential  factor 
in  covering  the  necessary  studies  of  an  osteopathic  curriculum. 

In  order  that  the  student  may  read  these  chapters  intelli- 
gently he  must  have  concluded  at  least  ten  months  of  study 
of  Biology,  Histology,  Anatomy  and  Physiology.  These  sub- 
jects form  the  basis  of  the  science  of  osteopathy. 

The  author  has  kept  in  touch  with  the  growth  of  osteo- 
pathy from  year  to  year,  through  careful  perusal  of  its  pub- 
lished books  and  periodicals. 

The  contents  of  this  book  are  the  condensed  results  of  the 
author's  study  of  recognized  medical  text  books  on  Anatomy, 
Physiology,  Histology,  Pathology,  Bacteriology  and  Diagnosis, 
of  the  works  of  the  founder  of  Osteopathy,  Dr.  A.  T.  Still, 
Hazzard,  Riggs,  Henry  and  McConnell,  of  six  years'  expe- 
rience in  the  clinics  of  the  Pacific  School  of  Osteopathy,  and  the 
Infirmary  in  connection  with  this  college,  and  six  years  of 
continuous  teaching,  two  of  which  were  devoted  to  Anatomy 
and  Physiology  and  the  remaining  four  to  Theory  and  Prac- 
tice of  Osteopathy  and  Physical  Diagnosis. 

To  enumerate  the  books  from  whose  pages  facts  have  been 
gleaned  for  corroborative  testimony  concerning  the  Principles 
of  Osteopathy  is  impossible.  Books  have  been  read  and  laved 


8  PKEFACE. 

aside  and  what  is  here  written  may  be  the  result  of  something 
which  caught  the  author's  attention  for  a  moment  only  and  then 
became  a  maverick. 

The  illustrations  to  elucidate  the  text  have  been  furnished 
principally  by  the  laboratories  and  clinics  of  the  Pacific  School 
of  Osteopathy.  Without  the  hearty  and  efficient  aid  of  my  as- 
sociates on  the  faculty  of  this  college  much  of  the  concise  detail 
of  this  book  would  have  been  impossible.  I  am  indebted  to 
several  osteopathic  physicians  for  drawings  of  histological  tis- 
sues which  they  had  prepared  during  their  college  work.  They 
are  given  credit  under  their  drawings. 

The  large  number  of  excellent  photographs  of  microscopic 
structures,  patients  and  movements  is  the  result  of  the  skill 
of  J.  O.  Hunt,  D.  O.  A  few  of  the  photographs  were  made  by 
M.  E.  Sperry,  D.  O.,  who  also  took  great  care  to  see  that  we 
had  the  best  of  photographic  lenses  with  which  to  work.  I 
am  also  greatly  indebted  to  C.  H.  Phinney,  D.  O.,  and  J.  E. 
Stuart,  D.  O.,  for  their  accurate  demonstration  of  osteopathic 
movements. 

My  thanks  are  extended  to  Miss  Louisa  Burns,  B.  S.,  for 
reading  the  manuscript  and  suggesting  corrections  therein, 
also  to  Miss  Gertrude  Smith  for  preparing  the  manuscript  for 
the  publisher. 

DAIN  L.  TASKER,  D.  O.,  D.  Sc.  O. 


PREFACE  TO  SECOND  EDITION. 

Three  chapters  have  been  added  to  the  present  edition. 
These  fit  logically  into  the  work  as  it  appeared  in  the  first 
edition.  Since  Osteopathy  is  a  rapidly  developing  school  of 
medicine  new  conditions  give  occasion  for  a  broader  and 
more  definite  conception  of  the  work  of  the  Osteopath.  In 
this  second  edition  an  effort  has  been  made  to  correct  the 
errors  of  the  first  and  to  add  such  matter  as  will  bring  the 
work  up  to  date  and  maintain  its  standing  as  a  concise  ex- 
position of  the  Principles  of  Osteopathy. 

The  author  feels  indebted  to  many  kind  readers  who 
have  called  attention  to  typographical  and  other  errors. 
Thanks  are  especially  due  Dr.  C.  A.  Whiting  for  a  careful 
criticism  of  the  book.  It  is  hoped  the  errors  previously  ap- 
pearing have  been  practically  eliminated. 

Los  Angeles,  Calif.,  May  2ist,  1905. 


TABLE   OF   CONTENTS. 


CHAP.  I. — The  Cause  of  Disease. — Potential  and  Kinetic  En- 
ergy— A  Normal  Stimulus — A  Change  in  Resist- 
ance— Resistance — Cause  and  Effect — Cell  Rela- 
tions— Excessive  Stimulation — Structural  Defects — 
Cell  Life  Dependent  on  Circulation — Osteopathic 
Therapeutics — Incidents  in  the  History  of  a  Disease 
Process — Fatigue  and  Excess — Methods  of  Cure — 
Subluxations  are  Mechanical  and  Chemical  Stimuli. 

CHAP.  II. — Structural  and  Contractile  Tissues. — The  Cell — 
Structural  Tissues — Contractile  and  Elastic  Tissues — 
Metabolic  Tissues — Irritable  Tissues — Circulatory 
Tissues — 'Mechanical  Principles — Displacement  by 
Violence,  Passive — Obstruction  to  Vital  Forces — Pri- 
mary and  Secondary  Lesions — Displacement  by  Mus- 
cular Contraction,  Active — Summary — Contractile 
Tissue — Amoeboid  Motion,  Contraction — Stimuli — 
Direct  and  Indirect  Stimulation — Structural  Tissues 
Affected  by  Contraction — Circulation  of  Blood  in 
Muscle — Effect  of  Contraction,  Intrinsic — Extrin- 
sic— Summary. 

CHAP.  III. — Irritable  Tissue. — Nerve  Tissue — Irritability- 
Conductivity — Trophicity — Unity  of  the  Nervous 
System — Mechanical  Irritation — Double  Conduc- 
tion— Nerve  Bundles — Central  Nervous  System — 
Segmentation — Reflex  Action — Practical  Applica- 
tion— Efferent  Nerves — Sympathetic  Ganglia — Diag- 
nosis— Objective  Symptoms — Co-ordination  of  Sen- 
sations— Example. 


TABLE    OF    CONTEXTS.  n 

CHAP.  IV. — Circulatory  Tissue. — Functions — Lymph — Blood 
— Blood  Corpuscles,  Red — White — Chemical  Constitu- 
ents— Distribution  of  the  Blood — Circulatory  Appara- 
tus— The  Heart — Regulation  of  Contraction — Co-ordi- 
nating Centers — The  Pneumogastric  Xerve — Accel- 
erator Center — Stimulation  of  Heart — Inhibition  of 
the  Heart — Vaso-Motor  Control  of  the  Coronary  Art- 
eries— Angina  Pectoris — Action  of  the  Heart  Centers, 
The  Depressor  Nerve — Vaso-motor  Nerves — Vaso- 
constriction — Vaso-dilation — Summary — The  Sensory 
Xerves — Capillary  Circulation  —  Recapitulation  — 
Vaso-motor  Centers — Conclusions' —  Pathology  — 
Therapeutics — Case  Illustrations. 

CHAP.  V. — Secretary  Tissue. — Metabolism — Epithelium — 
— Protective  Epithelium — Secretory  Epithelium — 
Sensory  Epithelium — Gland  Formation — Sexual 
Cells  —  Summary  —  Arrangement  of  Gland 
Cells  —  Filtration,  Osmosis  and  Diffusion  — 
The  Individual  Cell — Secretory  Xerve  Fibers 
— The  Xew  Viewpoint — Necessary  Conditions 
for  Secretion — Classes  of  Drugs  which  Affect 
Secretion — Unimpeded  Blood  Supply — Proper  Food — 
Innervation — Osteopathic  Pathology — Therapeutics — 
Direct  Manipulation — Hyperaemia  of  the  Governing 
Center — Effect  on  Heart  Beat — Classes  of  Stimuli- 
Perspiration — Secretion  of  the  Digestive  Tract — 
Pulmonary  Respiration — Importance  of  the  Cell. 

CHAP.  VI. — The  Sympathetic  Nervous  System. — Unity  of 
the  Nervous  System — Origin — Lateral  Ganglia — Four 
Prevertebral  Plexuses— Visceral  Ganglia — Communi- 
cating Fibers — White  Rami-communicantes — Distri- 
bution—  Function —  Gray  Rami-communicantes  — 
Distribution — Function — Functions  of  the  Sympa- 
thetic System — Independent  or  Dependent — Ganglia 
— Cervical  Ganglia  of  Importance  to  Osteopaths — 
Superior  Cervical  Ganglion — Connections — Vaso- 
constriction — Distribution — Headache — Middle  Cer- 


12  TABLE    OF    CONTENTS. 

vical  Ganglion — Distribution —  Function — Manipu- 
lation— Inferior  Cervical  Ganglion  — Distribution  — 
Function  —  Manipulation  —  Recapitulation  -  -  The 
Thoracic  Ganglia — Rami-efferentes —  Upper  Five 
Thoracic  Ganglia — Nerve  Distribution — The  Inter- 
scapular  Region — A  Case  Illustrating  the  Cilio- 
spinal  Center — Effects  of  Treatment,  First  to  Seventh 
Dorsal — Great  Splanchnic — Lesser  Splanchnic — Least 
Splanchnic — Functions — Theory — Lumbar  Ganglia — 
Sacral  Ganglia — Distribution  —  Function  —  Cardiac 
Plexus — Position  and  Formation — Pulmonary  Plexus 
— Physiology  —  Functions  —  Treatment  —  Results 
— Argument — Solar  Plexus — Location  and  Formation 
—  Distribution  —  Function  —  Centers  —  Hypogastric 
Plexus — Location  and  Formation — Pelvic  Plexus — 
Distribution — Subsidiary  Plexuses — Function — Sum- 
mary— Automatic  Visceral  Ganglia — Conclusion. 

CHAP.  VII.— Hilton's  Law.— The  Law  Stated— Methods  ot 
Studying  Anatomy — Example  of  Hilton's  Law — The 
Knee — Object  of  such  a  Distribution — Uniformity  of 
the  Law — Precision  of  Nerve  Distribution  to  Muscles 
— Indications  for  the  Use  of  Therapeutics — The  Use 
of  Hilton's  Law  in  Physical  Diagnosis — Comparison 
of  Methods — Herpes  Zoster — The  Distribution  of  an 
Intercostal  Nerve — Some  of  the  Evil  Effects  of  Rest — 
Head's  Law — Application  of  the  Law — The  Viscera — 
Nerves  of  Conscious  Sensation. 

CHAP.  VIII.  — Lesions. — History — Treatment — Muscular 
Contraction — Classes  of  Lesions — Causes  of  Lesions 
— Diagnosis  of  Lesions — Changes  Due  to  Growth. 

CHAP.  IX. —  Subluxations. — Definition — Diagnosis — Prima- 
ry or  Secondary  Lesions — Analysis — Occipito-atlantal 
Articulation — The  Causes  of  Subluxation — The  Atlas 
and  Axis — Unequal  Development — Caries — Spontane- 
ous Reduction — Cervical  Vertebrae — Dorsal  Vertebrae 


TABLE    OF    CONTEXTS.  13 

— False  Lesions — Lateral  Subluxations — Muscular 
Contraction — Comparison  of  Effects  of  Muscular 
Contraction — Separation  of  Spinous  Processes — Ap- 
proximation of  Spinous  Processes — Subluxations,  Pri- 
mary— Subluxations,  Secondary — Limited  Area  for 
Lateral  Subluxations — Characteristics  of  the  8th  to  the 
1 2th  Dorsal  Vertebrae — Dorso-Lumbar  Articulation — 
Kyphosis,  Lower  Dorsal — The  Lumbar  Region — Ex- 
amination of  the  Ribs — Costo-central  Articulation — 
Costo-transverse  Articulation — Co-ordination — Inco- 
ordination — Nervous  Control  of  Respiration — Costal 
Subluxations — First  Rib — Tenth  Rib — Eleventh  and 
Twelfth  Ribs — Effect  of  Position  of  Vertebrae  on  the 
Position  of  Ribs — Clavicles — Sacro-iliac  Articulation 
— The  Nerves  Affected — Symptoms — Sacro-vertebral 
Articulation — Summary. 

CHAP.  X. — Sounds  Produced  in  Joints  by  Manipulation. — 
Normal  Sounds — Abnormal  Sounds — Pathology  of 
Joints  Producing  Abnormal  Sounds. 

CHAP.  XI. — Osteopathic  Centers. — Diagnosis — First  Four 
Cervical  Nerves — Example  of  Hilton's  Law — The 
Pneumogastric  Nerve — The  Hypoglossal  Nerve — 
Superior  Cervical  Ganglion — Sub-occipital  Triangles 
— Cervical  Plexus — Intensity  of  Reflexes — The 
Spinal  Accessory — The  Phrenic  Nerve,  Hiccoughs 
— The  Trapezius  and  Splenius  Capitis  et  Colli 
Muscles — Vaso-motion,  Head,  Face  and  Neck — 
Affections  of  the  Cervical  Nerves — Brachial  Plexus — 
Affections  of  the  Brachial  Nerves — A  Case  of  Hemi- 
paresis  below  the  Fifth  Cervical  Vertebra — Subluxa- 
tion  of  the  Scapula — The  Nerve  of  Wrisberg — The 
Interscapular  Region — The  Lung  Center — Cilio-spinal 
Center — Heart  Center — Stomach  Center — Liver  and 
Spleen  Center — Leukemia — Large  Intestine — Small  In- 
testine— Center  for  Chills — The  Language  of  Pain — 
Osteopathic  View  of  Pathology — Center  for  the  Gall- 


14  TABLE    OF    CONTEXTS. 

bladder — A  Case  Report — Intestines — Uterus — Ova- 
ries and  Testes — Kidney — Second  Lumbar — Paraple- 
gia— Lumbar  and  Sacral  Plexuses — The  Bladder — 
Sphincter  Vaginae — Conclusions. 

CHAP.  XII.— Symptomatology.— The  Functional  Activity 
of  any  Organ  or  Tissue  is  Proportional  to  the  Circu- 
lation of  Blood  which  Nourishes  it. 

CHAP.XIII.  GermTheory  of  Disease. — Specific  Causes — Con- 
ditions which  Affect  Life — Resistance — Immunity — 
Specific  Treatment — Summary. 

CHAP. XIV.  Compensation  and  Accommodation. — Definition 
— The  Spinal  Column — Compensatory  Curvature — The 
Extremities — The  Thorax — Skin  and  Kidneys — The 
Heart — Power  of  Encysting. 

CHAP.  XV. — Inhibition. — Acceleration — Inhibition  —  Mus- 
cular Contraction — Secretion — Acceleration  and  Inhi- 
bition as  Attributes  of  Nerve  Tissue — Is  the  Work 
Done  Proportionate  to  the  Strength  of  Stimuli — Inhibi- 
tion a  Normal  Attribute  of  the  Central  Nervous  Sys- 
tem— Physiological  Activity  is  a  Result  of  Stimulation 
—  Hilton's  Law  —  Inhibition  —  Therapeutics  —  How 
Vaso-motor  Centers  Act — Over-stimulation  equals  In- 
hibition— The  Guide  for  the  Use  of  Inhibition — Patho- 
logical Changes  which  Accompany  Over-stimulation — 
Rational  Treatment — Hyperaesthesia  of  Sensory 
Areas,  Diagnostic — Results  of  Inhibition — The  Phrase 
"Remove  Lesions" — The  Human  Body  is  a  Vital  Mech- 
anism— Structure  vs.  Function — Osteopathic  Meaning 
of  Inhibition — The  Scientific  Use  of  Inhibition — Inhi- 
bition as  a  Local  Anaesthetic — Inhibition  May  Act 
without  Removing  a  Lesion — Inhibition  to  Remove 
Lesions — Passive  Movements  vs.  Rest — Inhibition  as 
a  Preparatory  Treatment. 

CHAP.  XVI.— Positions  for  Examination. — Testing  Align- 
ment and  Flexibility — Sense  of  Touch — Inspection — 


TABLE    OF   CONTENTS.  15 

Palpation  of  the  Ribs — Palpation  of  the  Spine — Ex- 
trinsic and  Intrinsic  Muscles  of  the  Back — The  Diag- 
nostic Value  of  Hyperaesthesia — Testing  Muscular 
Tension — Thoracic  Flexibility — Examination  of  the 
Abdomen — Elevation  or  Depression  of  Ribs — Examin- 
ation of  the  Rectum  and  Prostate  Gland — Examination 
of  the  Neck — The  History  of  Lesions — The  Extremi- 
ties— Subjective  Symptoms. 

CHAP.  XVII.— Manipulation. — Method  of  Procedure — Relax- 
ation of  the  Latissimus  Dorsi — Relaxation  of  the  Tra- 
pezius — Relaxation  of  the  Rhomboids — The  Pectoralis 
Major  and  Serratus  Magnus — Quadratus  Lumborum 
— The  Erector  Spinae — Treatment  of  Simple  Kypho- 
sis — Lordosis — Upper  Dorsal — The  Variety  of  Move- 
ments which  will  secure  the  Same  Results — The  Head 
and  Neck  as  a  Lever — Lordosis  or  Kyphosis  may  Affect 
a  Function  Similarly — Splenius  Capitis  et  Colli — Ky- 
phosis, Upper  Dorsal — Kyphosis,  Dorso-lumbar — 
Contra-indications — Other  Movements — Dorsal  Rota- 
tion— Lateral  Curvature — Know  how  to  Apply  Prin- 
ciples— Do  not  Copy  Movements. 

CHAP. XVIII.  Reduction  of  Subluxations. — Lateral  Subluxa- 
tion — Lower  Dorsal — A  Depressed  Spine — Kyphosis, 
Pott's  Disease — Rib  Subluxations. 

CHAP.  XIX.—  Treatment  of  the  Cervical  Region. — To  Raise 
the  Clavicle — Subluxation  of  the  Clavicle — Prepara- 
tory Treatment  of  the  Neck,  Trapezius — Sterno-cleido- 
mastoid — Scaleni — Splenius  Capitis — Extension — Ro- 
tation— The  Hyoid  Bone — Mylo-hyoid  and  Hyoglossus 
— Sterno-thyroid  and  Sterno-hyoid — Intrinsic  Muscles 
of  the  Larynx — The  Atlas — Sixth  Cervical. 

CHAP.  XX. —  Treatment    of    the    Extremities. — Diagnosis 
— Causes  of  Stiff  Joints,  Ankylosis — The  Scapulo-hu- 
meral     Articulation — Examination     of     the     Brachial 


16  TABLE    OF    CONTENTS. 

Plexus — Reduction  of  Dislocation  by  Traction — By 
Leverage — Elbow  Articulation — The  Radius — Old 
Dislocations — Muscles  of  the  Lower  Extremities — 
Quadriceps  Extensor — The  Adductor  Group — Disloca- 
tion of  the  Femur — Stretching  the  Sciatic — The  Calf 
Muscles — Scientific  Manipulation — Saphenous  Open- 
ing— Popliteal  Space. 

CHAP.  XXI.  —Manipulation  for  Vaso-Motor  Effects.— The 
Fifth  Cranial  Nerve — Inhibition  of  the  Sub-occipital. 


INTRODUCTION. 


Great  strides  have  been  made  during  the  past  twenty-five 
years  in  the  practice  of  medicine.  The  relative  positions  for- 
merly held  by  drug  therapy  and  surgery  have  been  completely 
reversed.  The  concoctions  of  the  pharmacopoeia,  with  their 
vague  and  uncertain  effects  upon  human  tissues  and  functions, 
no  longer  entice  the  earnest  seeker  after  medical  truths  to  spend 
a  lifetime  experimenting  with  substances  which  are  absolutely 
foreign  to  the  human  body. 

There  was  a  time,  not  far  away,  when  that  person  who 
treated  human  diseases  by  manipulation,  water,  diet  and  gen- 
eral hygiene  was  considered  to  be  the  chief  of  impostors.  Go 
a  little  farther  back  in  the  history  of  medicine  and  we  see  sur- 
gery dishonored  because  it  was  mechanical,  not  mystical 
enough  for  the  ponderous  minds  whose  forte  it  was  to  deal 
with  strange  substances  of  the  animal,  vegetable  and  mineral 
kingdoms. 

During  all  the  years  in  which  drug-therapy  flourished 
there  were  a  few  real  scientists  who  devoted  time  and  talents 
to  the  structure  of  our  bodies  and  the  function  of  each  part 
Discoveries  came  slowly  along  these  lines  because  the  majority 
of  medical  men  were  concentrating  their  energies  on  ferreting 
out  the  effects  of  drugs.  Facts  in  anatomy  and  physiology 
which  are  so  patent  to  us  at  this  time,  remained  obscure  for 
centuries  simply  because  there  was  no  thought  of  studying  the 
form  and  action  of  tissues,  while  all  nature  outside  of  our  own 
bodies  seemed  to  be  a  grand  laboratory  of  specifics  for  human 
ailments. 

If  osteopathy  had  been  born  fifty  years  ago,  it  would  have 
died  because  the  popular  and  scientific  minds  were  not  in  a 
condition  to  receive  it.  Even  the  time  at  which  it  was  born. 


i8  INTRODUCTION. 

scarcely  twenty-five  years  ago,  was  hardly  ripe  for  this  new 
departure  in  medicine.  Ten  years  easily  cover  the  period 
of  its  active  history. 

A  Scientific  Growth. — There  is  one  distinctive  point 
about  osteopathy  which  should  be  especially  emphasized :  It 
is  not  an  empirical  system ;  nothing  is  done  on  the  cut  and  try 
plan.  It  has  been  developed  in  a  purely  scientific  way.  We 
might  observe  the  action  of  the  human  body  in  health  and 
disease  indefinitely  without  securing  any  exact  data  to  pass  on 
to  the  next  generation  of  observers  if  we  fail  to  know  the  struc- 
ture of  the  body.  A  physician  may  learn  many  things  in  an 
empirical  way  which  are  very  poor  assets  for  science. 

The  strange  part  of  medical  history,  to  the  modern  inves- 
tigator, is  the  fact  that  discoveries  in  anatomy  and  physiology, 
which  are  of  such  vital  importance  to  the  successful  treatment 
of  human  diseases,  were  left  stored  away  between  the  covers 
of  books,  not  deemed  of  any  value  except  to  whet  the  mind  of 
the  dilletante  in  medicine. 

Osteopathy  as  a  distinct  system  of  medicine  has  grown 
to  its  present  proportions  at  a  time  when  the  older  schools 
of  medicine  are  making  radical  changes  in  their  therapeutical 
procedures,  e.  g.,  serum-therapy.  In  spite  of  all  these  so- 
called  scientific  advances  in  drug-therapy,  osteopathy  has  made 
steady  advance  into  public  favor,  thereby  showing  that  it  is 
fully  able  to  compete  with  the  older  systems  of  practice. 

The  Founder  of  Osteopathy.— Dr.  A.  T.  Still,  of  Kirks- 
ville,  Mo.,  is  the  honored  founder  of  this  system  of  therapeu- 
tics. His  early  work  was  of  that  persistent,  plodding  char- 
acter which  is  necessary  in  order  to  build  a  firm  foundation 
for  accurate  observation  in  later  years.  He  did  not  sit  and  lis- 
ten to  flowing  sentences  from  the  mouths  of  lecturers,  and 
straightway  assert  that  certain  things  are  causes  of  disease. 
His  work  was  in  studying  the  structure  of  our  bodies  directly, 
and  thus  gain  an  accurate  knowledge  of  how  bones,  ligaments 
and  muscles,  blood-vessels,  glands  and  nerves  are  placed. 
Then  he  sought  that  department  of  knowledge  which  we  call 
physiology,  and  learned  how  these  tissues  act  in  health.  Hav- 
ing had  previous  training  in  treating  diseases  by  the  drug  meth- 


INTRODUCTION.  19 

od,  he  was  slow  to  discard  the  old  method  for  one  which  had 
never  been  tried,  even  though  it  had  good  scientific  reasons 
back  of  it.  But  the  substitution  did  take  place  by  degrees 
until  his  system  of  therapeutics  no  longer  made  use  of  drugs. 

It  seems  to  be  a  popular  idea  that  it  is  necessary  for  the 
founder  of  a  system  to  have  a  creed  or  statement  of  belief. 
We  do  not  doubt  but  that  it  is  good  for  us  at  times  to  try  to  put 
our  beliefs  in  writing,  not  to  form  a  fixed  position,  but  just  as 
the  architect  draws  many  plans  to  gradually  develop  his  mental 
pictures.  These  statements  usually  contain  the  truth  about 
our  work  so  far  as  we  know  it.  We  can  thus  see  how  far  we 
have  advanced  and  realize  that  we  have  much  to  learn. 

Dr.  Still  has,  from  time  to  time,  expressed  the  result  of 
his  studies,  that  is,  the  observed  facts  upon  which  he  has 
built  his  system  of  therapeutics.  In  1874,  Dr.  Still  stated  his 
observations  as  follows :  "A  disturbed  artery  marks  the  period 
to  an  hour,  and  minute,  when  disease  begins  to  sow  its  seeds 
of  destruction  in  the  human  body.  That  in  no  case  could  it 
be  done  without  a  broken  or  suspended  current  of  arterial 
blood  which,  by  nature,  is  intended  to  supply  and  nourish  all 
nerves,  ligaments,  muscles,  skin,  bones  and  the  artery  itself. 
*  *  *The  rule  of  the  artery  must  be  absolute,  universal,  and 
unobstructed,  or  disease  will  be  the  result.  *  *  All 

nerves  depend  wholly  upon  the  arterial  system  for  their 
qualities,  such  as  sensation,  nutrition  and  motion,  even  though 
by  the  law  of  reciprocity  they  furnish  force,  nutrition,  and 
sensation  to  the  artery  itself." 

Definitions. — Many  definitions  have  been  formulated 
and  published  to  the  world.  Each  one  tends  to  limit  one's  con- 
ception of  osteopathy  in  some  particular.  A  definition  always 
limits  the  thing  defined,  therefore,  no  definition  of  osteopathy 
can  be  complete,  because  we  are  dealing  with  a  principle,  the 
universality  of  which  no  one  knows.  Whereas,  less  than  seven 
years  ago,  it  was  thought  that  osteopathy  was  an  excellent 
method  of  treating  chronic  ailments,  we  now  find  osteopaths 
working  day  and  night  at  the  bedside  of  the  acutely  sick.  Thus 
does  it  spread  and  become  thoroughly  recognized  as  a  system 
applicable  to  all  diseases. 


20  INTKODUCTIOX. 

In  order  to  bring  before  the  student  as  full  and  compre- 
hensive an  idea  of  the  scope  of  osteopathy  as  possible,  a  series 
of  definitions  are  quoted.  These  definitions  have  been  taken 
from  current  osteopathic  literature  and  are  credited  to  their  re- 
spective authors. 

One  of  the  short  paragraphs  in  Dr.  Still's  autobiography 
is  sufficient  to  give  a  clear  understanding  of  his  idea  of  the 
human  body.  "The  human  body  is  a  machine  run  by  the  un- 
seen force  called  life,  and  that  it  may  be  run  harmoniously,  it 
is  necessary  that  there  be  liberty  of  blood,  nerves  and  arteries 
from  the  generating  point  to  destination." 

The  following  definition  is  one  which  has  been  used  in 
the  American  School  publications  for  a  long  time:  "Osteo- 
pathy is  that  science  which  consists  of  such  exact,  exhaustive 
and  verifiable  knowledge  of  the  structures  and  functions  of  the 
human  mechanism,  anatomical,  physiological  and  psychologi- 
cal, including  the  chemistry  and  physics  of  its  known  elements 
as  has  made  discoverable  certain  organic  laws  and  remedial 
resources,  within  the  body  itself,  by  which  nature,  under  the 
scientific  treatment  peculiar  to  osteopathic  practice,  apart  from 
all  ordinary  methods  of  extraneous,  artificial,  or  medicinal 
stimulation,  and  in  harmonious  accord  with  its  own  mechanical 
principles,  molecular  activities,  and  metabolic  processes,  may 
recover  from  displacements,  disorganizations,  derangements, 
and  consequent  disease,  and  regain  its  normal  equilibrium  of 
form  and  function  in  health  and  strength."  Mason  W. 
Pressly,  A.  B.,  Ph.  D.,  D.  O. 

"Osteopathy  is  that  science  of  healing  which  emphasizes, 
(a)  the  diagnosis  of  disease  by  physical  methods  with  a  view 
to  discovering  not  the  symptoms  but  the  causes  of  diseases,  in 
connection  with  misplacements  of  tissue,  obstruction  of  the 
fluids  and  interference  with  the  forces  of  the  organism ;  (b) 
the  treatment  of  diseases  by  scientific  manipulations  in  con- 
nection with  which  the  operating  physician  mechanically  uses 
and  applies  the  inherent  resources  of  the  organism  to  overcome 
disease  and  establish  health,  either  by  removing  or  correcting 
mechanical  disorders,  and  thus  permitting  nature  to  recuperate 
the  diseased  part,  or  by  producing  and  establishing  antitoxic 


INTRODUCTION.  21 

and  antiseptic  conditions  to  counteract  toxic  and  septic  con- 
ditions of  the  organism  or  its  parts ;  (c)  the  application  of  me- 
chanical and  operative  surgery  in  setting  fractured  or  dislo- 
cated bones,  repairing  lacerations  and  removing  abnormal  tis- 
sue growths  or  tissue  elements  when  these  become  dangerous 
to  the  organic  life."  J.  Martin  Littlejohn,  LL.  D.,  M.  D.,  D.  O. 
"Osteopathy  is  a  school  of  mechanical  therapeutics  based 
on  several  theories,  i.  Anatomical  order  of  the  bones  and 
other  structures  of  the  body,  is  productive  of  physiological 
order,  i.  e.,'ease  or  health  in  contradistinction  to  disease  or  dis^- 
order  which  is  usually  due,  directly,  or  indirectly,  to  anatomical 
disorder.  2.  Sluggish  organs  may  be  stimulated  mechanically 
by  way  of  appropriate  nerves  (frequently  by  utilizing  re- 
flexes) or  nerve  centers.  3.  Inhibition  of  over-active  organs 
may  be  effected  by  steady  pressure  substituted  for  the  mechan- 
ical stimulation  mentioned  above.  4.  Removal  of  causes  of 
faulty  action  of  any  part  or  organ  is  the  keynote  of  the 
science."  C.  M.  Case,  M.  D.,  D.  O. 

" Thus    the    word     (osteopathy)     has 

come  to  mean  that  science  which  finds  in  disturbed  mechan- 
ical relations  of  the  anatomical  parts  of  the  body  the  causes 
of  the  various  diseases  to  which  the  human  system  is  liable; 
that  science  which  cures  disease  by  applying  technical  knowl- 
edge and  high  manual  skill  to  the  restoration  of  any  or  all  dis- 
turbed mechanical  relations  occurring  in  the  body."  Chas. 
Hazzard,  Ph.  B.,  D.  O. 

"Osteopathy  means  that  science  or  system  of  healing 
which  treats  diseases  of  the  human  body  by  manual  thera- 
peutics for  the  stimulation  of  the  remedial  and  resisting  forces 
within  the  body  itself,  for  the  correction  of  misplaced  tissue 
and  the  removal  of  obstructions  or  interferences  with  the 
fluids  of  the  body,  all  without  the  internal  administration  of 
drugs  or  medicines."  Chas.  C.  Teall,  D.  O. 

"Osteopathy  is  that  school  of  medicine  whose  distinctive 
method  consists  in  (i)  a  physical  examination  to  determine 
the  condition  of  the  mechanism  and  functions  of  all  parts  of 
the  human  body,  and  (2)  a  specific  manipulation  to  restore  the 


22  INTRODUCTION. 

normal  mechanism  and  re-establish  the  normal  functions. 
This  definition  lays  stress  (i)  upon  correct  diagnosis.  The 
osteopath  must  know  the  normal  and  recognize  any  departure 
from  it  as  a  possible  factor  in  disease.  There  is  not  one  fact 
known  to  the  anatomist  or  physiologist  that  may  not  be  of 
vital  importance  to  the  scientific  osteopath.  Hence  a  correct 
diagnosis  based  upon  such  knowledge  is  half  the  battle.  With- 
out it  scientific  osteopathy  is  impossible  and  the  practice  is 
necessarily  haphazard  or  merely  routine  movements.  The 
definition  lays  stress  upon  (2)  removal  of  the  cause  of  disease. 
A  deranged  mechanism  must  be  corrected  by  mechanical 
means  specifically  applied  as  the  most  natural  and  only  direct 
method  of  procedure.  This  work  is  not  done  by  any  of  the 
methods  of  other  schools.  After  the  mechanism  has  been  cor- 
rected little  remains  to  be  done  to  restore  function;  but  stimu- 
lation or  inhibition  of  certain  nerve  centers  may  give  tempo- 
rary relief  and  aid  nature.  The  adjuvants  used  by  other 
schools,  such  as  water,  diet,  exercise,  surgery,  etc.,  are  the 
common  heritage  of  our  profession  and  should  be  resorted  to 
by  the  osteopath  if  they  are  indicated."  E.  R.  Booth,  Ph.  D., 
D.  O. 

"i.  Osteopathy  is  a  physical  method  of  treating  disease 
without  drugs. 

2.  Osteopathy  is  applied  physiology. 

These  two  definitions  refer  to  osteopathy  in  its  broad 
sense. 

3.  The  cell  is  the  unit  of  the  body  which  inherits  its 
vitality.     This  vitality  is  kept  up  by  pabulum  received  from 
the  blood,  while  the  waste  is  carried  away  by  the  lymph  and 
venous  streams. 

The  differentiated  cell  to  be  able  to  trophize  properly 
must  receive  a  nerve.  Every  cell  has  the  inherent  capacity 
to  recuperate  after  injury,  and  as  the  nervous  system  controls 
the  circulation  of  the  blood,  it  follows  that  any  abnormality 
of  position  or  size  of  any  tissue  or  any  change  in  the  chemical 
constitution  of  a  tissue  leads  to  disease. 

The  nervous  system  yields  most  readily  to  mechanical 
stimuli,  therefore  osteopathy  is  the  art  of  treating  disease  by 


INTRODUCTION.  23 

physical  and  mechanical  means ;  the  science  of  aiding  the  vital 
processes  by  means  of  stimulation  or  inhibition  of  nerves, 
and  by  the  removal  of  lesions  or  obstructions."  J.  W.  Hof- 
sess,  D.  O. 

"Osteopathy  is  a  complete  system  of  healing,  wherein 
only  food  and  water  is  allowed  to  enter  the  stomach,  and  all 
natural  means  are  employed  to  place  a  diseased  body  under 
such  conditions  as  will  permit  nature  to  effect  a  cure,  includ- 
ing the  most  effective  dietetic  and  hygienic  measures,  such  as 
suggestion,  fasting,  exercise  and  hydrotherapy ;  special  use 
being  made  of  manipulations  that  normalize  the  tonicity  of 
muscles,  the  flow  of  blood  and  lymph,  the  transmission  of  nerve 
force  and  the  functioning  of  bodily  organs  by  replacing  de- 
ranged anatomical  structures,  stretching  and  pressing  mus- 
cles, vessels  and  nerves,  freeing  the  movements  of  joints 
and  correcting  dislocations  and  subluxations."  C.  W.  Young, 
D.  O. 

"Osteopathy  is  that  science  or  system  of  healing  which, 
using  every  means  of  diagnosis,  with  a  view  to  discovering, 
not  only  the  symptoms,  but  the  causes  of  disease,  seeks,  by 
scientific  manipulations  of  the  human  body,  and  other  physical 
means,  the  correcting  and  removing  of  all  abnormalities  in 
the  physical  relations  of  the  cells,  tissues  and  organs  of  the 
body,  particularly  the  correcting  of  misplacements  of  organs 
or  parts,  the  relaxing  of  contracted  tissues,  the  removing  of 
obstructions  to  the  movements  of  fluids,  the  removing  of 
interferences  with  the  transmission  of  nerve  impulses,  the 
neutralizing  and  removing  of  septic  or  foreign  substances 
from  the  body;  thereby  restoring  normal  physiological  pro- 
cesses, through  the  re-establishment  of  normal  chemical  and 
vital  relations  of  the  cells,  tissues  and  organs  of  the  body,  and 
resulting  in  restoration  of  health,  through  the  automatic  stim- 
ulation and  free  operation  of  the  inherent  resistant  and 
remedial  forces  within  the  body  itself."  C.  M.  Turner  Hulett. 
D.  O. 

"Osteopathy  is  that  science  which  reasons  on  the  human 
system  from  a  mechanical  as  well  as  a  chemical  standpoint, 
taking  into  consideration  in  its  diagnosis,  heredity,  the  habits 


24  INTRODUCTION. 

of  the  patient,  past  and  present ;  the  history  ot  the  trouble,  in- 
cluding symptoms,  falls,  strains,  injuries,  toxic  and  septic 
conditions,  and  especially  in  every  case  a  physical  examination 
by  inspection,  palpation,  percussion,  auscultation,  etc.,  to  de- 
termine all  abnormal  physical  conditions ;  the  treatment  em- 
phasizing scientific  manipulation  to  correct  mechanical  lesions, 
to  stimulate  or  inhibit  and  regulate  nerve  force  and  circula- 
tory fluids  for  the  recuperation  of  any  diseased  part,  using 
the  vital  forces  within  the  body;  also  the  habits  of  the  patient 
are  regulated  as  to  hygiene,  air,  food,  water,  rest,  exercises, 
climate  and  baths,  such  means  as  hydropathy,  electricity,  mas- 
sage, antidotes  and  antiseptics,  and  suggestion  sometimes  being 
used  as  adjuncts."  Chas.  C.  Reid,  D.  O. 

"Osteopathy  is  a  method  of  treating  disease  by  manipu- 
lation, the  purpose  and  result  of  which  is  to  restore  the  normal 
condition  of  nerve  control  and  blood  supply  to  every  organ 
of  the  body  by  removing  physical  obstruction,  or  by  stimu- 
lating or  inhibiting  functional  activity  as  the  condition  may 
require."  Wilfred  L.  Riggs,  D.  O. 

"Osteopathy  is  a  system  of  medicine,  characterized  by 
close  adherence  to  the  physiological  axiom  that  perfect  health 
depends  on  a  perfect  circulation,  and  perfect  nerve  control  in 
every  tissue  of  the  body.  Its  etiology  emphasizes  physical 
perversions  of  tissue  relations  as  causes  of  disease.  Its  diag- 
nosis is  mainly  dependent  on  the  discovery  of  physical  lesions 
by  means  of  palpation.  Its  therapeutics  comprehends  (i) 
manipulation,  including  surgery,  for  purposes  of  readjusting 
tissue  relations;  (2)  scientific  dietetics;  (3)  personal  and  pub- 
lic hygiene."  Dain  L,.  Tasker,  D.  O. 

The  above  definitions  have  nearly  all  been  taken  from 
the  Journal  of  the  American  Osteopathic  Association. 

Osteopathic  Diagnosis. — Physical  diagnosis  is  and  al- 
ways will  be  the  leading  factor  in  the  success  of  Osteopathic 
practitioners.  This  ability  to  take  hold  of  an  ailing  human 
being  and  detect  the  disturbing  factor  in  it,  is  the  highest  at- 
tainment of  the  physician.  Osteopathy  has  developed  the  art  of 
palpation  to  a  wonderful  degree.  Basing  this  art  on  a  definite 
knowledge  of  structure  =md  function  makes  it  the  chief  reliance 


IXTRODUCTIOX.  25 

in  diagnosis.  Every  physical  diagnosis  begins  with  palpa- 
tion and  proceeds  with  auscultation  and  percussion,  and  not 
failing  to  use  chemical  and  microscopical  methods  when 
necessary.  The  student  must  learn  to  use  his  sense  of  touch 
continually,  in  fact,  learn  to  see  with  his  fingers.  Add  to  this 
development  of  touch  a  training  in  chemical  and  microscopical 
analysis  of  secretions  and  excretions  of  the  body,  and  we  have 
a  practitioner  thoroughly  equipped  to  make  an  accurate  scien- 
tific diagnosis. 

Osteopathic  Therapeutics. — Osteopathic  treatment  is 
based  on  this  kind  of  physical  diagnosis  which  we  have  just 
described.  It  takes  into  account  the  fact  that  the  organism  is 
a  self- recuperating  mechanism  and  requires  proper  food, 
proper  surroundings,  and  perfect  activity  of  every  tissue,  espe- 
cially the  blood.  Thus  we  divide  treatment  into  three  di- 
visions, (i)  manipulation  for  the  purpose  of  correcting  the 
mal-position  of  any  tissue,  whether  that  tissue  be  bone  or 
blood;  (2)  proper  feeding,  i.  e.,  dietetics;  and  (3)  proper 
surroundings,  i.  e.,  hygiene. 

If  the  condition  of  the  body  is  such  that  none  of  the 
three  methods  just  mentioned  will  right  the  difficulty,  i.  e.,  if 
there  are  broken  bones,  ruptured  muscles  and  connective  tis- 
sues or  false  growths,  we  can  then  use  surgical  means. 
Surgery  is  a  part  of  the  Osteopathic  system,  just  as  it  is  of  all 
systems  of  medicine.  The  chief  assurance  lies  in  the  fact  that 
the  osteopathic  system  is  very  conservative  as  regards  the  use 
of  the  knife. 

Osteopathy  includes  all  those  qualities  which  make  up  a 
successful  system ;  its  diagnosis  is  accurate  and  its  treatment 
is  comprehensive,  including  scientific  manipulations,  scientific 
dietetics,  hygiene  and  surgery. 

In  a  recent  article  in  the  American  Monthly  Review  of 
Reviews,  the  following  sentences  appear:  "With  but  few 
exceptions,  the  entire  vegetable  and  mineral  kingdoms  have 
given  us  little  of  specific  value;  but  still,  up  to  the  present 
day,  the  bulk  of  our  books  on  materia  medica  is  made  up  of  a 
description  of  many  valueless  drugs  and  preparations.  Is  it 
not  to  be  deplored  that  valuable  time  should  be  wasted  in  our 


26  INTRODUCTION. 

student  days  by  cramming  into  our  heads  a  lot  of  therapeutic 
ballast." 

This  is  probably  the  most  recent  statement  of  this  kind  in 
the  public  prints.  It  substantiates  the  position  taken  by  the 
osteopathic  colleges.  We  feel  justified  in  claiming  that  os- 
teopathy today  occupies  a  position  which  every  other  system 
of  medicine  must  come  to  sooner  or  later.  It  is  broad  enough 
and  liberal  enough  to  accept  truth  wherever  demonstrated. 
Its  foundations  being  laid  in  the  basic  sciences,  and  its  treat- 
ment never  departing  from  the  facts  of  these  sciences,  make 
it  a  system  of  lasting  worth  and  capable  of  adding  an  entirely 
new  conception  of  the  phenomena  of  life  to  medical  litera- 
ture. 

The  formation  of  the  name  osteopathy  (from  osteon, 
bone,  and  pathos,  suffering)  seems  to  be  as  perfect  a  descrip- 
tive name  as  it  is  possible  to  form  which  would  cover  the 
basic  principle  of  the  science.  The  bones  are  the  foundation 
upon  which  all  the  soft  tissues  are  laid,  and  the  osteopath 
makes  all  his  examinations,  using  them  as  fixed  points  from 
which  to  explore  for  faulty  arrangement.  The  name  does 
not  mean  bone  disease,  but  since  the  osteopath  finds  many 
diseases  resulting  from  pressure  due  to  slightly  displaced  bone, 
the  name  is  used  in  the  sense  of  disease  caused  by  bone.  We 
do  not  consider  that  all  diseases  are  caused  by  displaced  bone, 
but  it  is  a  cause  which  has  heretofore  been  overlooked.  We 
recognize  that  there  are  many  causes  of  disease,  and  do  not 
wish  to  be  understood  as  trying  to  fit  fact  to  theory,  but  as  a 
result  of  observing  certain  facts,  this  basic  principle  of  os- 
teopathy has  been  made  clear. 

We  believe  that  health  is  the  natural  state,  and  that  this 
condition  is  bound  to  be  maintained  so  long  as  every  cell  has 
an  uninterrupted  blood  supply,  and  its  controlling  nerve  is 
undisturbed.  Therefore,  the  first  effort  of  the  osteopath  is 
to  remove  all  obstructions  to  blood  and  nerve  supply,  feeling 
certain  that  when  these  obstructions  are  removed,  health  will 
follow.  Hilton  in  his  lectures  on  "Rest  and  Pain,"  which  are 
considered  medical  classics,  has  expressed  himself  forcibly  on 
this  subject,  as  follows:  "It  would  be  well,  I  think,  if  the 


INTRODUCTION.  27 

surgeon  would  fix  upon  his  memory,  as  the  first  professional 
thought  which  should  accompany  him  in  the  course  of  his 
daily  occupation,  this  physiological  truth — that  nature  has  a 
constant  tendency  to  repair  the  injuries  to  which  her  struc- 
tures may  have  been  subjected,  whether  those  injuries  be  the 
result  of  fatigue  or  exhaustion,  of  inflammation  or  accident. 
Also  that  this  reparative  power  becomes  at  once  most  con- 
spicuous when  the  disturbing  cause  has  been  removed;  thus 
presenting  to  the  consideration  of  the  physician  and  surgeon  a 
constantly  recurring  and  sound  principle  for  his  guidance  in 
his  professional  practice." 

Every  system  of  curing  human  ills,  which  is  based  on 
the  known  facts  of  anatomy  and  physiology  will  last,  because 
it  is  true.  When  systems  of  drug  medication  are  known  only 
as  history,  osteopathy  will  be  ministering  to  the  human  race, 
because  it  knows  no  other  path  than  that  which  leads  to 
greater  truths  in  physiology  and  anatomy. 


PEIXCIPLES  OF  OSTEOPATHY.  29 


CHAPTER  1. 


THE  CAUSE  OF  DISEASE. 

Potential  and  Kinetic  Energy. — The  cause  of  disease 
is  in  the  cells  of  the  body.  They  contain  the  stored  energy, 
i.  e.,  potential  energy.  When  this  potential  energy  is  released 
by  some  other  force,  or  stimulus,  we  have  kinetic  energy. 
Potential  energy  cannot  transfer  itself  spontaneously  into 
kinetic  energy  without  first  being  affected  by  some  other  force 
which  may  be  called  a  stimulus.  The  amount  of  potential 
energy  converted  into  kinetic  is  not  proportional  to  the  amount 
of  the  stimulus  used  to  initiate  the  process.  All  stored  energy, 
i.  e.  potential  energy,  requires  a  certain  strength  of  stimulus 
to  start  the  process  of  conversion  into  kinetic.  When  this 
strength  of  stimulus  is  known  it  is  called  the  normal.  There 
are  usually  several  kinds  of  stimuli,  each  one  having  a  vary- 
ing degree  of  intensity.  For  example,  the  potential  energy 
in  a  muscle  fiber  will  be  converted  into  kinetic  energy  as  a 
result  of  mechanical,  thermal,  chemical  or  electrical  stimuli. 
Certain  amounts  of  each  of  these  stimuli  are  required  to 
initiate  the  change  in  the  form  of  energy. 

A  Normal  Stimulus. — The  potential  energy  in  a  muscle 
fiber  has  a  certain  degree  of  resistance  to  stimuli.  A  definite 
amount  of  any  one  of  the  four  forms  of  stimuli  named  is 
necessary  to  cause  the  muscle  fibre  to  contract.  This  definite 
amount,  which  is  capable  of  stimulating  the  muscle  to  an 
average  contraction  is  called  the  normal  stimulus,  and  the 
action  of  the  muscle  is  called  the  normal  contraction.  If  the 
muscle  should  contract  more  vigorously  than  usual  in  re- 


3o  PRINCIPLES  OF  OSTEOPATHY. 

sponse  to  this  normal  stimulus,  the  resistance  of  the  potential 
energy  of  the  muscle  fibre  is  below  normal.  The  strength  of 
stimulus  and  discharge  of  energy  may  vary  greatly  in  their 
proportions  within  normal  limits,  but  there  are  well  marked 
lines  above  or  below  which  resistance  is  spoken  of  as  above 
or  below  normal. 

A  Change  of  Resistance. — When  the  resistance  of  the 
potential  energy  is  below  normal,  a  normal  stimulus  causes 
too  great  an  effect,  that  is,  too  much  potential  energy  is  trans- 
ferred into  kinetic  energy.  When  the  resistance  of  the  po- 
tential energy  is  normal,  and  the  stimulus  above  normal,  there 
also  results  an  excessive  discharge  of  potential  energy.  There- 
fore, excessive  discharge  results  from  lowered  resistance,  or 
increase  of  stimulus. 

Resistance. — Resistance  is  a  quality  of  the  cell  proto- 
plasm. The  stimulus  is  an  external  force. 

The  cell  depends  on  proper  surroundings  in  order  to 
maintain  its  resistance  to  external  ?timuli,  such  as  bacteria. 
The  strength  of  bacteria  may  also  be  increased  or  decreased 
by  the  nature  of  their  surroundings. 

Cause  and  Effect. — After  potential  energy  has  been 
changed  into  kinetic  energy,  this  latter  may  generate 
more  potential  energy,  and  this  also  may  be  converted  into 
kinetic.  Thus  cause  is  converted  into  effect  and  effect  into 
cause.  This  is  an  endless  chain.  When  such  a  process  is 
beyond  the  normal,  as  in  the  body  when  varying  symptoms 
present  themselves,  therapeutic  efforts  must  be  concentrated 
on  some  one  particular  reflex  in  order  to  break  the  chain. 

Cell  Relations. — The  relations  of  a  cell  with  its  fellows 
that  is,  its  structural  relations,  are  the  basis  upon  which  its 
resistance,  in  large  measure,  depends.  Therefore,  anything 
which  disarranges  its  normal  relations  will,  in  all  probability, 
change  its  resistance  to  stimuli.  All  therapeutic  methods 
which  aim  at  lessening  the  too  rapid  conversion  of  potential 
into  kinetic  energy,  that  is,  increasing  cell  resistance,  must 
see  that  correct  structure  is  attained. 

Excessive  Stimulation. — In  cases  where  almost  com- 
plete exhaustion  of  potential  energy  has  resulted  from  lowered 


PRINCIPLES  OF   OSTEOPATHY.  31 

resistance  and  we  find  that  even  increased  strength  of  stimulus 
fails  to  evoke  a  response,  the  same  structural  fault  may  exist. 
We  know  that  stimulation,  when  excessive,  passes  into  inhi- 
bition. Perhaps  it  is  truer  to  state  that  over  activity  of  a 
cell  leads  to  exhaustion  of  its  potential  energy.  The  stage  of 
exhaustion,  in  this  sense,  is  consonant  with  inhibition.  As  an 
example :  In  case  of  structural  changes  in  the  lumbar  re- 
gion, there  may  result  a  change  in  resistance  in  the  secretory 
and  contractile  cells  of  the  intestines  due  to  changed  blood 
supply.  Diarrhoea  results  for  a  time,  followed  by  constipa- 
tion. At  the  beginning  of  the  rapid  conversion  of  potential 
into  kinetic  energy  the  muscles  feel  tense.  After  the  consti- 
pation, or  period  of  exhaustion,  sets  in,  they  are  flabby. 

Structural  Defects. — Structural  defects  may  result  in 
lowered  resistance  in  groups  of  cells.  They  also  act  as 
stimuli  to  set  free  the  potential  energy  in  these  cells.  In  many 
cases  we  note  only  a  predisposition  to  yield  to  weak  stimuli. 
This  is  the  condition  in  individuals  who  are  "fairly  well,"  but 
cannot  endure  any  of  the  normal  stimuli  in  average  amount. 
They  cannot  exercise  freely  without  a  bad  reaction.  A  slightly 
heavier  meal  than  usual ;  the  excitement  due  to  the  presence  of 
many  people  arouses  "symptoms."  Their  physiological  pro- 
cesses are  easily  perverted  by  normal  stimuli  because  a  struc- 
tural defect,  either  directly  or  indirectly,  has  decreased  cell 
resistance.  Cases  of  lowered  resistance,  supposed  to  be  due  to 
heredity,  should  be  carefully  examined  for  structural  defects. 
It  is  not  improbable  that  many  an  ancestor  is  wrongly  accused 
of  transmitting  a  "predisposition." 

While  cell  resistance  remains  below  normal,  all  external 
stimuli,  such  as  atmospheric  changes  and  presence  of  bacteria, 
even  if  in  only  normal  amounts,  may  call  forth  "symptoms  of 
disease." 

Cell  Life  Dependent  on  Circulation. — The  individual 
cells  of  the  body  depend  on  the  supply  of  nourishment  brought 
to  them  by  the  circulating  fluids  of  the  body.  The  protoplasm  of 
the  cells  is  a  complex,  chemical  substance  made  up  of  an  enor- 
mous number  of  complex  molecules.  These  molecules,  on  ac- 
count of  the  looseness  of  combination  of  their  atoms,  require 


32  PRINCIPLES  OF  OSTEOPATHY. 

sufficient  crude  material  brought  to  them  to  maintain  the 
proper  atomic  tension.  Upon  this  tension  is  based  the  re- 
sistance to  normal  or  abnormal  stimuli. 

The  necessary  food  for  cell  protoplasm  is  brought  to  the 
cells  by  blood  and  lymph.  Since  cell  protoplasm  is  entirely 
dependent  upon  the  circulating  media,  any  disturbance  of  these 
media  changes  the  metabolism  of  the  cell,  and  hence  a  change 
in  resistance  results.  This  resistance  may  be  varied  by  failure 
on  either  the  arterial  or  venous  side  of  the  general  circulation, 
resulting  in  changed  lymph  circulation.  The  constant  removal 
of  katabolic  products  is  of  as  much  importance  as  the  constant 
renewal  of  material  for  anabolism. 

Intracellular  tension,  i.  e.,  the  cohesiveness  of  the  atoms 
of  each  molecule,  is  dependent  on  lymphatic  circulation,  this 
upon  arterial  and  venous  circulation.  If  there  is  abnormal  va- 
riation in  any  of  these  circulatory  fluids,  there  results  a  change 
in  resistance  of  the  cells.  Therefore  a  normal  stimulus  may 
provoke  too  great  a  transference  of  potential  into  kinetic  en- 
ergy and  thus  initiate  a  chain  of  such  transferences  of  one 
form  of  energy  into  another.  As  a  rule,  the  kinetic  energy 
which  results  from  the  release  of  potential  energy  in  excessive 
amounts  acts  as  a  stimulus  to  release  still  more  potential 
energy  and  so  on  to  the  point  of  exhaustion  of  the  supply  of 
such  stored  energy.  This  change  is  exemplified  in  the  series 
of  symptoms  which  appear  in  many  diseases.  Each  liberation 
of  a  new  supply  of  energy  gives  rise  to  a  new  symptom.  If 
the  potential  energy  resides  in  a  gland,  excessive  secretion  re- 
sults ;  if  in  muscle,  excessive  contraction,  etc.  The  way  in 
which  the  kinetic  energy  is  manifested  depends  upon  the 
manner  in  which  its  cause,  i.  e.,  potential  energy,  is  stored. 
The  secretion  or  the  contraction  may  act  as  a  stimulus  to  lib- 
erate still  more  potential  energy. 

Osteopathic  Therapeutics. — Therapeutics  of  osteo- 
pathic  medicine  are  addressed :  First,  to  correction  of  struc- 
ture with  consequent  increase  of  cell  resistance  to  stimuli ; 
second,  to  reducing  the  intensity  and  power  of  external 
stimuli  to  or  below  normal. 

"In  no  case  can  anything  appear  in  the  form  of  disease 


PEIXCIPLES   OF  OSTEOPATHY.  33 

which  was  not  previously  present  in  the  body  as  a  predisposi- 
tion; external  forces  are  able  merely  to  make  this  predispo- 
sition apparent.  .  .  .  When  the  physician,  by  thorough 
observation  and  investigation,  knows  the  conditions  that  influ- 
ence a  given  predisposition  in  a  definite  way,  when  he  is 
scientifically  trained  and  has  a  true  conception  of  hygiene,  and 
is  at  once  physician  and  naturalist,  then  he  is  able  to  cure 
disease  by  use  of  the  very  same  forces  which  serve  to  create 
or  alter  the  human  constitution.  In  this  simple  sense  there 
is  a  true  art  of  healing."  Hueppe's  Principles  of  Bacteriology. 
Page  249. 

It  is  therefore  necessary  that  anatomy  should  hold  the 
most  important  position  among  the  studies  requisite  for  a 
thorough  understanding  of  osteopathic  therapeutics.  Physi- 
ology, the  normal  reaction  of  cells  to  normal  stimuli,  is  next  in 
importance.  The  study  of  external  stimuli  may  be  compre- 
hended under  the  titles  Hygiene  and  Bacteriology.  Symptoms 
are  the  surface  play  of  kinetic  energy.  They  lead  to  a  broad 
understanding  of  vital  phenomena. 

Incidents  in  the  History  of  a  Disease  Process. — Other 
schools  of  medicine  note  uric  acid  or  bacteria  as  causes  of  dis- 
ease processes.  Osteopathic  etiology  views  these  as  incidents 
in  the  history  of  disease  processes.  The  cause  lies  in  the  cells 
and  their  lowered  resistance  to  normal  stimuli.  The  condi- 
tion of  lowered  resistance  is  viewed  as  a  result  of  structural 
changes  which  interfere  with  the  nerve  control  of  the  indi- 
vidual cells  with  the  lymphatic  circulation  upon  which  the 
cells  depend  for  nourishment.  These  changes  strike  at  the 
very  root  of  tissue  life  and  resistance,  hence  open  the  way  for 
external  stimuli  to  cause  too  great  a  discharge. 

The  presence  of  bacteria  is  of  little  moment  until  cell  re- 
sistance has  been  reduced  sufficiently  to  allow  them  to  grow 
and  manufacture  their  poisonous  products. 

A  fall  or  sprain  may  be  responsible  for  a  slight  sublux- 
ation  of  a  rib.  This  subluxation  affects  the  nutrition  of  the 
cells  forming  the  lungs,  resistance  is  lowered.  Bacilli  of 
tuberculosis  may  be  present  in  the  inspired  air.  They  find  a 
fertile  spot  in  this  area  of  lessened  resistance.  Resistance 


34  PEINCIPLES  OF   OSTEOPATHY. 

must  be  increased  in  this  area  in  order  to  head  off  the  disease 
process.  Nature  has  two  methods  of  overcoming  the  disease. 
First,  she  tries  to  eliminate  it  from  the  body;  failing  in  this, 
she  tries  to  compensate  for  it  by  throwing  the  burden  of 
work  on  some  other  tissue,  or  again,  to  accommodate.  We 
see  compensation  illustrated  by  increase  of  heart  muscle  in 
case  of  dilation.  Accommodation  is  illustrated  by  forming  a 
wall  of  connective  tissue  around  a  diseased  area,  thus  prac- 
tically eliminating  that  area  from  direct  physiological  activity 
with  the  rest  of  the  body,  even  though  it  is  actually  within  the 
body.  This  last  process  is  to  all  intents  and  purposes,  equiva- 
lent to  the  first,  i.  e.,  elimination. 

Whether  the  illness  be  ascribed  to  uric  acid  or  bacteria, 
there  is  something  back  of  these  which  has  been  the  cause. 
Some  disturbance  of  the  normal  metabolism  has  resulted  in 
the  formation  and  retention  of  uric  acid.  We  consider  that 
some  structural  lesion,  in  the  area  of  the  spine  from  which  the 
nerves  of  the  gastro-intestinal  tract  emanate,  must  have  dis- 
turbed the  normal  rythm. 

When  rheumatism  of  an  extremity  exists,  we  do  not  use 
salicylates,  but  we  examine  the  structures  which  might  affect 
the  innervation  and  circulation  of  the  extremity. 

Fatigue — Excess. — Although  structure  is  examined 
with  the  fact  in  mind  that  it  may  affect  function,  we  do  not 
forget  the  fact  that  function  may  affect  structure.  With  this 
in  view,  we  are  interested  in  knowing  what  effects  may  have 
resulted  from  fatigue  of  any  organ  or  the  entire  body,  the  ef- 
fects of  excess  in  eating,  drinking  or  sexual  intercourse. 

We  have  stated  that  increase  of  normal  stimuli  may  cause 
a  lessened  resistance.  Thus  indulgence  in  pleasurable  sensa- 
tions, whether  of  eating,  drinking  or  sexual  intercourse  may 
result  in  structural  defects  and  lessened  resistance. 

Methods  of  Cure. — To  cure  these  various  conditions, 
we  use  manipulations  and  surgical  methods  to  correct  struc- 
tural defects  in  so  far  as  it  is  possible.  Resistance  is  thus  in- 
creased. External  stimuli  are  decreased  so  far  as  possible. 
Hygienic  living  and  antiseptics  aid  in  decreasing  external 
stimuli.  Water  may  be  sterilized  to  eliminate  any  typhoid 


PRINCIPLES  OF   OSTEOPATHY.  35 

bacilli,  mosquitos  killed  to  check  malarial  infection.  These 
are  recognized  as  methods  of  decreasing  external  stimuli. 

Subluxations  Are  Mechanical  and  Chemical  Stimuli.  - 
Physiological  writers  mention  four  forms  of  stimuli  of  muscle 
and  nerve,  mechanical,  chemical,  thermal  and  electrical.  The 
will  may  be  named  as  a  fifth  form.  Osteopathic  medicine  rec- 
ognizes a  sixth  form  which  may  be  mechanical  or  chemical. 
It  is  the  stimulation  occasioned  by  the  pressure  of  bone, 
muscle,  or  ligament  upon  nerve  fibres  or  blood  vessels.  If  the 
pressure  is  exerted  directly  upon  a  nerve  bundle,  the  stimula- 
tion is  mechanical ;  if  it  affects  the  metabolism  of  other  tissues 
as  a  result  of  obstruction  to  circulation,  the  nerve  endings 
are  affected  by  chemical  stimulation.  This  is  an  etiological 
factor  not  reckoned  with  in  other  schools  of  medicine.  It  is  a 
distinctive  feature  of  osteopathic  medicine. 

A  twisted  rib  affords  an  example  of  this  form  of  stimu- 
lation affecting  nerve  fibres  in  relation  with  it.  The  intercostal 
nerves  supply  motor  fibres  to  the  intercostal  muscles,  sensory 
and  secretory  fibres  to  the  pleura  and  skin.  The  irritation  re- 
sulting from  a  twisted  rib  pressing  upon  the  intercostal  nerve 
may  result  in  intercostal  neuralgia,  pleurisy,  or  herpes,  com- 
monly called  "shingles."  If  the  irritation  is  removed,  that  is, 
the  rib  brought  into  proper  relation  with  its  fellows,  the  neural- 
gia, pleurisy  or  herpes  is  cured.  They  are  the  symptoms  of  a 
disturbed  nerve.  The  stimulating  impulses,  originated  by  the 
pressure,  cause  changes  in  the  activity  of  the  tissues  which  are 
innervated  bv  the  irritated  nerve. 


36  PRINCIPLES  OF  OSTEOPATHY. 

CHAPTER  II. 
STRUCTURAL  AND  CONTRACTILE  TISSUES. 

The  Cell. — Mechanical  and  vital  phenomena  are  stud- 
ied carefully  by  the  osteopath.  In  order  to  know  these  phe- 
nomena and  correctly  interpret  them  he  must  first  study  the 
structure  and  functions  of  the  cell. 


- 


Fig.   i. — Unicellular  organisms  possessing  all    the  vegetative  and  vital  attributes. 

The  attributes  of  this  small  element  of  the  body  are  both 
vegetative  and  vital.  Its  vegetative  attributes  are  three: 
metabolism,  growth  and  reproduction.  Its  vital  attributes  are 
irritability  and  motion. 


PRINCIPLES   OF  OSTEOPATHY.  37 

Following  these  natural  divisions  we  find  that  the  col- 
lections of  cells  to  form  tissues  divide  themselves  into  groups 
possessing  definite  qualities  or  attributes  corresponding  to  one 
or  the  other  of  these  vegetative  or  vital  attributes  of  the  orig- 
inal cell. 


Fig.  2. — Photomicrograph  of  dividing  cells.  Cross  section  of  young  white  fish, 
Coregonus.  From  slide  prepared  by  Prof.  B.  M.  Davis,  Biologist  in  State 
Normal  School,  Los  Angeles,  Cal. 


As  the  original  cell  divides  and  redivides  we  find  certain 
groups  of  cells  perpetuating,  modifying  and  intensifying  some 
special  attribute  of  the  parent  cell.  Naturally,  as  osteopaths, 
and  following  lines  of  tissue  development,  we  are  interested, 
first,  in  following  the  lines  of  development  of  structural  tissues. 

Structural  Tissues. — Under  this  head  we  collect  a  con- 
siderable number  of  tissues  whose  function  or  special  labor  is 
to  support  the  more  active  tissues.  They  give  form  and  sta- 


38  PRINCIPLES   OF   OSTEOPATHY. 

bility  to  the  body.     Bone,  cartilage,  ligament,  tendon,  fascia 
and  connective  tissue  form  this  class. 


Fig.    3. — Cross   section   of   bone.      Camera    lucida   drawing  by   A.    M.    Hewitt,    In- 
structor in  the  Physiology  of  the  Eye,  Pacific  School  of  Osteopathy. 

Contractile  and  Elastic  Tissues. — Muscle  and  elastic 
ligaments  constitute  this  class  and  serve  to  infuse  action  into 
the  combination  of  structural  tissues  just  named. 


Fig.   4. — Muscle   fibers,   striated.      Camera   lucida    drawing  by   J.    E.    Stuart,   D.    O. 

Muscle  unites  two  attributes  of  the  original  cell,  i.  e.,  it  is 
a  vegetative  structural  tissue  and  a  vital  motor  tissue.  This 
combination  of  attributes  brings  about  many  strange  phe- 
nomena, as  we  shall  see  later. 


Fig.   5. — Yellow   elastic   tissue.      Camera   lucida   drawing  by   A.   M.   Hewitt. 


PRINCIPLES  OF   OSTEOPATHY. 


39 


Yellow  elastic  tissue  as  we  find  it  in  the  ligamentum 
nuchae  and  the  ligamenta  subflava  must  be  considered  as  some- 
thing more  than  structural  tissue,  hence  we  place  it  in  this 
class. 

Metabolic  Tissues. — No  sharp  lines  of  demarcation  are 
drawn  here.  We  name  those  tissues  whose  cellular  elements 
exercise  the  power  of  preparing  food  for  other  tissues  or  of 
excreting  waste  material ;  glandular  tissue,  mucous  membrane, 
serous  membrane  and  skin  form  this  class. 


Fig.  6. — Kidney  of  a  cat.     XSQO.     a,    Glomeruli:   b.  Loops  of  Henle  or  collecting 
tubules.      Drawn  by  A.   M.   Hewitt. 


Fig.      7. — Medulated      nerve      fibers.      Drawn    by    A.    M.    Hewitt 

Irritable  Tissues. — Muscle  and  nerve  are  the  sole  oc 
cupants  of  this  class. 


40  PE1NCIPLES  OF  OSTEOPATHY. 

The  tissues  thus  far  mentioned  constitute  the  form  and 
solid  substance  of  a  human  cadaver.  If  tissues  could  live  in- 
dependently of  each  other  as  amoeba  live,  then  we  might  have 


Fig.  8. — Nerve  cells,  in  different  stages  of  development,  from  the  cerebrum  of  a 
fetal  rabbit  two  or  three  days  before  birth.  The  cells  from  i  to  7  are  Golgi 
cells  of  the  first  type.  No.  8  is  a  Glia  cell  from  the  same  preparation.  Xiso. 
Original  drawing  by  C.  H.  Phinney,  D.  O. 

life  in  this  accumulation  of  cells,  but  since  this  is  not  possible 
we  must  add  other  tissues. 

Circulatory  Tissues. — These  are  blood  and  lymph. 
They  are  vital  to  all  that  have  just  been  mentioned. 

The  blood  and  lymph  are  the  media  of  exchange. 

The  nerves  are  the  media  of  communication. 

Blood  and  nerves  complete  the  connection  between  all 
other  tissues  and  fill  us  with  wonder  at  the  many  phenomena 
caused  by  their  activity.  By  considering  blood  as  a  tissue,  we 
are  not  violating  imagination  nor  becoming  transcendentalists. 

"Every  tissue  is  composed  of  two  parts;  the  cellular  ele- 
ments and  the  intercellular  elements.  Upon  the  first  of  these 
depends  the  vitality  of  the  tissue,  while  its  physical  properties 
are  determined  by  the  character  of  the  second.  The  physical 
condition  of  the  intercellular  substances  includes  a  wide  latitude, 
varying  from  that  of  fluid,  as  blood  or  lymph,  through  all 
degrees  of  density  until  by  the  additional  impregnation  of 
calcareous  matters,  the  well-known  hardness  of  bone  or  dentine 
is  attained."  (Piersol.) 

Mechanical  Principles. — Our  next  step  is  to  consider 
some  of  the  attributes  of  these  several  classes. 

Osteopathy  has  been  built  up  on  the  mechanical  idea  of  the 
body  rather  than  the  vital ;  i.  e.,  in  the  thought  of  the  average 


PRINCIPLES   OF   OSTEOPATHY. 


osteopath,  form  and  structure,  mechanical  pressure,  leverage, 
bony  pressure,  etc.,  have  preceded  the  more  complex  vital  phe- 
nomena which  make  up  the  picture  of  disease  in  older  schools 


Fig.  9. — Blood  Corpuscles  under  high  magnification,  i,  Groups  of  Red  cells;  a, 
End  view  of  Red  cells;  3,  Crenated  corpuscles  (Red);  4,  PolymoOphous  Leuco' 
cyte;  5,  Mononucle_ar  Leucocyte;  6,  Polynuclear  Leucocyte;  7,  Eosinophyle 
corpuscle;  8.  Transitional  Leucocyte;  9,  Rouleau  of  Red  corpuscles.  Drawn 
by  A.  M.  Hewitt. 

of  medicine.  Therefore,  in  order  to  follow  the  subject  along 
the  lines  of  its  development,  we  will  consider  the  structural 
tissues  first. 

Displacement  by  Violence — Passive. — Structural  tis- 
sues may  be  displaced  by  violence.  The  human  body  receives 
a  vast  number  of  falls,  slips,  jars,  etc.,  which  are  liable  to 
destroy  the  delicate  adjustment  of  its  bony  parts.  The  chief 
wonder  is  that  we  do  not  have  more  serious  results  in  a  larger 
number  of  cases. 

Up  to  the  time  of  the  advent  of  osteopathy  in  the  field 
of  medicine  this  etiological  factor  in  disease  was  not  taught. 
Slight  structural  displacements  can  not  be  successfully  noted 
unless  the  diagnostician  has  been  carefully  trained  in  anatomy. 
All  the  successes  of  the  early  osteopaths  were  achieved  by 
hands  trained  to  make  use  of  anatomical  therapeutics. 


42  PRINCIPLES   OF   OSTEOPATHY. 

It  is  not  enough  that  an  osteopathic  physician  should  be 
able  to  recognize  improper  positions  of  bony  parts ;  his  ob- 
servation and  his  thought  do  not  halt  here,  but  follow  the 
normal  physiological  action  in  the  immediate  and  remote  areas, 
then  he  realizes  what  pathological  conditions  may  result  from 
the  physiological  perversion. 

Obstruction  to  Vital  Forces.-  Since  structural  tissues 
are  surrounded  by  vital  tissues,  irritable  and  circulatory,  we 
may  state  the  next  proposition  as  follows :  Displaced 
structural  tissues  make  pressure  on  irritable  and  circulatory 
tissues.  This  proposition,  simplified,  means  obstruction  to 
vital  forces.  When  the  displacement  takes  place  far  from  the 
centers  of  vitality,  that  is,  the  spinal  cord  and  brain,  the  re- 
sulting perversion  of  function  is  not  very  wide  spread.  For 
example,  the  displacement  of  a  tarsal  bone  will  not  create  the 
disturbance  that  would  be  found  as  the  result  of  a  vertebral 
or  costal  subluxation. 

The  result  of  the  pressure  is  a  change  in  the  normal 
metabolism  in  the  deranged  area.  If  the  media  of  commu- 
nication and  exchange  are  cut  off  by  this  pressure,  then  met- 
abolism is  bound  to  suffer  in  the  injured  area  or  by  reflex 
nervous  irritability,  a  changed  metabolism  is  found  in  a  distant 
area.  This  does  not  mean  that  only  points  distal  to  the  seat 
of  injury  will  be  affected  because  their  means  of  communica- 
tion and  exchange  have  been  cut  off,  but  that  an  area  appar- 
ently having  no  direct  connection  with  the  injured  part  may 
show  metabolic  changes  because  its  nerve  supply  is  given  off 
from  the  same  central  area,  and,  in  want  of  a  better  word  to 
express  my  meaning,  acts  in  sympathy  with  the  injured  part. 

Cartilage  may  become  subluxated  in  some  localities  and 
be  the  disturbing  factor.  For  example,  in  the  knee  or  temporo- 
maxillary  articulations.  Ligaments  may  be  strained  and  the 
resulting  thickening  cause  obscure  pressure  symptoms.  This 
is  especially  true  of  spinal  ligaments. 

Primary  and  Secondary  Lesions. — Bear  in  mind  that 
thus  far  we  have  considered  all  of  our  disturbances  to  be  the 
result  of  external  violence,  and  are  hence  primary  etiological 
factors  of  disease.  No  perfect  cure  can  be  expected  unless 


PRINCIPLES  OF   OSTEOPATHY.  43 

this  primary  disturbance  is  righted  and  obstruction  to  the 
vital  forces  removed.  Early  osteopathic  literature  noted 
especially  these  bony  lesions  and  urged  the  osteopath  to  search 
diligently  for  them  and  remove  them.  The  great  value  to 
humanity  of  this  method  is  amply  proven  by  a  multitude  of 
cases  in  every  State.  If  all  lesions  were  of  this  character 
and  primary,  there  would  be  little  need  of  my  writing  farther, 
but  we  are  vital  mechanisms,  hence  complexity  of  arrange- 
ment and  reaction  draw  us  on  to  interpret  the  phenomena  met 
with  in  our  practice.  A  lesion,  according  to  osteopathic 
thought,  is  used  to  designate  any  derangement  of  tissue.  When 
they  are  recognized  or  considered  as  primary  lesions  they  are 
treated  as  the  first  cause,  if  they  are  recognized  as  resulting 
from  other  disturbances,  then  they  are  considered  as  secondary 
lesions,  but  this  does  not  preclude  the  idea  of  treating  them  as 
primary  and  hence  working  a  change  in  opposition  to  a  vic- 
ious cycle  of  reflexes.  A  secondary  lesion  may  be  the  result 
of  a  primary  one  and  at  the  same  time  be  the  primary  cause 
of  another  secondary  lesion  and  so  on  from  cause  to  effect 
and  on  again.  Herein  lies  the  opportunity  of  the  osteopath  to 
display  his  anatomical  and  physiological  knowledge  in  fol- 
lowing these  reflexes  by  a  process  of  exclusion  until  he  finds 
the  primary  one.  This  process  of  exclusion  often  requires  a 
considerable  time. 

Displacement  by  Muscular  Contraction — Active. — Our 
next  proposition  in  regard  to  structural  tissues  is  as  follows : 
They  may  be  deranged  by  excessive  activity  of  contractile 
tissue,  muscle.  This  brings  us  to  the  consideration  of  a 
tissue  which  is  both  structural  and  vital,  but  since  its  form 
and  attachments  are  merely  for  the  purpose  of  allowing  its 
vital  qualities  to  affect  other  tissues,  we  are  principally  inter- 
ested in  its  vital  attributes. 

Muscle  contracts  as  the  result  of  direct  mechanical  stimu- 
lation, such  as  a  pinch  or  prick ;  or  as  a  result  of  poisonous 
material  in  its  blood  supply ;  or  as  a  result  of  irritation  of  its 
controlling  nerve,  direct  or  reflex ;  also  in  response  to  sudden 
temperature  changes. 

With  these  four  means  of  stimulation  and  the  fact  that  in 


44  PRINCIPLES   OF   OSTEOPATHY. 

the  normal  body,  the  controlling  nerve  of  a  muscle  can  be 
stimulated  by  temperature,  pressure  or  poisonous  chemicals 
in  its  blood  supply,  the  fact  dawns  upon  us  that  since  muscles 
attach  to  bones,  ligaments,  tendons  and  fascia,  and  are  subject 
to  all  these  forms  of  irritation,  contraction  cannot  help  causing 
a  change  in  structural  tissues,  and  a  faulty  alignment  of  struc- 
tural tissues  will  be  manifested  to  the  osteopath's  fingers  as 
lesions,  primary,  perhaps,  to  the  minds  of  many,  but  in  reality 
secondary.  Another  form  of  displacement  of  structural  tissues 
may  be  the  result  of  secretory  tissues,  their  excessive  activity 
being  the  result  of  derangement  of  nerve  and  blood  supply. 
The  derangement  may  be  the  result  of  direct  or  reflex  irrita- 
tion to  the  controlling  nerves. 

Summary. — Thus  we  have  noted  three  forms  of  dis- 
placement of  structural  tissues ;  the  first  purely  the  result  of 
extrinsic  forces,  violence ;  the  second  and  third  resulting  from 
vital  activities.  Whether  the  displacement  be  a  primary  or 
secondary  cause  it  may  occasion  the  following  results :  The 
lesion  is  an  obstruction  to  blood  supply,  which  equals  a 
changed  metabolism  in  the  immediate  area,  resulting  in  irri- 
tation to  the  nerves  in  the  immediate  area  either  as  result  of 
pressure  or  lack  of  proper  food.  This  is  followed  by  an 
altered  blood  supply  in  distant  or  reflex  areas  through  action 
of  vaso-motor  nerves,  causing  changed  metabolism  in  said 
distant  or  reflex  area  resulting  in  weakened  tissue  through 
failure  of  proper  exchange  of  food  and  waste  elements.  This 
decreases  resistance  to  bacteria,  hence  opens  the  zvay  to  specific 
infection. 

To  picture  these  changes  more  vividly  we  will  state  them 
in  relation  to  some  specific  disease,  diphtheria  for  instance 
The  atlas  may  be  subluxated  as  a  result  of  violence,  such 
as  a  hard  fall  or  stepping  off  a  curb  without  being  conscious 
of  its  presence.  The  shock  and  consequent  strain  of  the 
muscles  causes  contraction  resulting  in  subluxation.  Both 
the  shock  and  the  resulting  subluxation  affect  circulation  in 
the  immediate  area,  thus  changing  the  metabolism  going  on 
in  the  suboccipital  triangles.  From  this  troubled  area  im- 
pulses are  carried  to  the  superior  cervical  sympathetic  gang- 


PRINCIPLES   OF  OSTEOPATHY.  45 

lion  in  such  numbers  and  force  that  the  normal  action  of  this 
ganglion,  vaso-constriction,  is  impaired.  The  nasal,  laryn- 
geal  and  pharyngeal  mucous  membranes  become  congested,  thus 
working  a  change  in  the  metabolism  of  their  cells  which 
gradually  decreases  their  normal  resistance  to  bacteria.  These 
weakened  tissues  which  are  exposed  to  the  air  are  now  in  a 
condition  to  yield  to  an  amount  of  infection  far  inferior  in 
strength  to  what  would  be  required  to  overcome  normal  re- 
sistance. 

This  is  an  illustration  of  the  osteopath's  method  of  rea- 
soning carried  through  to  the  point  of  specific  infection. 

The  same  train  of  reflexes  may  be  originated  by  cicatricial 
tissue  in  any  locality  where  the  wealth  of  nerve  connections 
or  capillary  circulation  is  sufficient  to  manifest  the  irritation. 

Contractile  Tissue. — It  has  been  noted  that  muscle  is 
a  structural  tissue,  but  its  vital  attribute  is  of  greater  interest. 
The  most  distinctive  thing  about  our  bodies  is  their  power 
to  move  spontaneously.  We  speak  of  being  quiet,  but  are 
never  so  in  life,  we  respond  to  every  change  about  us,  in- 
finitesimal changes  in  the  atmosphere,  every  change  is  an 
evidence  of  muscular  action.  One-half  of  our  bodies  in 
weight  consists  of  muscular  tissue  and  contains  about  one- 
quarter  of  the  whole  amount  of  blood.  It  is  muscular  tissue 
which  propels  the  blood  and  generates  heat,  in  fact  all  of  our 
functions  depend  on  the  muscles. 

Amoeboid  Motion — Contraction. — Your  studies  in  his- 
tology will  teach  you  the  minute  formation  of  muscular 
tissue,  hence  we  need  not  spend  time  on  that  division  of 
our  subject.  We  know  that  the  primative  cell  possesses  the 
power  of  moving,  called  amoeboid  motion,  that  in  the  pro- 
cess of  differentiation  of  tissues  muscular  tissue  is  the  spe- 
cialization of  this  attribute  of  the  primitive  cell.  One  form 
of  epithelium,  the  ciliated,  possesses  power  of  motion  in  its 
cilia.  Muscular  tissue  possesses  the  property  of  contraction, 
that  is,  the  power  to  draw  its  extremities  nearer  each  other. 
Owing  to  the  various  attachments  of  the  muscles  to  the  bones 
we  enjoy  the  ability  to  make  many  motions. 

Stimuli. — Through  the  exercise  of  our  wills    our  mus- 


46  PRINCIPLES   OF   OSTEOPATHY. 

cles  contract,  but  muscular  tissue  will  respond  to  other  kinds 
of  stimuli ;  for  instance,  if  a  muscle  fiber  is  pinched  it  will 
contract,  or  if  it  is  subjected  to  the  action  of  a  strong  acid 
it  will  contract.  Rapid  temperature  changes  affect  it  also. 
We  do  not  lose  sight  of  the  fact  that  in  the  normal  human 
body,  muscles  are  not  directly  exposed  to  the  action  of  ex- 
ternal stimuli  such  as  have  been  mentioned  but  they  do  re- 
spond to  these  stimuli  under  normal  conditions  through  the 
transference  of  the  stimulation  to  them  by  nerves.  When 
studying  the  phenomena  of  muscular  activity  in  the  living 
human  body,  we  are  compelled  to  constantly  reckon  with  the 
nerves  which  control  the  muscles.  We,  as  normal  beings,  act 
according  to  our  will.  In  order  to  control  our  muscles  there 
must  be  a  connection  between  the  brain  and  the  muscles. 
The  motor  nerves  carry  our  willed  action  to  the  muscles.  If 
these  nerves  are  cut  we  lose  control  of  the  muscles  in  which 
the  cut  nerves  end,  but  the  muscles  have  not  lost  the  power 
to  contract.  Contraction  is  a  property  of  the  muscle,  not  of 
the  nerve ;  the  nerve  conveys  the  normal  stimulus  which 
causes  the  muscle  to  contract.  The  sensory  nerves  which  are 
in  muscles  and  go  to  the  central  nervous  system,  convey  to 
our  brain  cells  a  knowledge  of  how  the  muscles  are  respond- 
ing to  our  orders. 

The  nerve  cells  in  our  spinal  cord  are  able  to  control 
many  motions  which  we  are  not  conscious  of,  hence  attitudes, 
and  positions  of  the  vertebrae  are  assumed  without  sensory 
nerves  informing  our  consciousness.  It  is  possible  therefore 
that  muscles  governed  by  these  spinal  nerve  cells  may  contract 
in  response  to  mechanical,  thermal  and  chemical  stimuli  with- 
out conscious  sensation  being  registered  on  the  sensorium  of 
our  brain. 

Direct  and  Indirect  Stimulation. — Two  propositions 
will  make  our  position  clear.  First,  Muscle  will  contract  in 
response  to  direct  mechanical,  thermal,  chemical  and  electrical 
stimuli.  Second,  Muscle  z\.'i!l  contract  in  response  to  indirect 
mechanical,  thermal,  chemical  and  electrical  stimuli.  We  have 
to  deal  almost  exclusively  with  the  indirect  stimuli.  It  is 
not  probable  that  muscles  ever  contract  as  a  result  of  direct 


PBIXCIPLES   OF   OSTEOPATHY.  47 

stimulation  while  they  are  under  nerve  control.  For  them  to 
be  subject  to  direct  stimulation  would  be  disastrous  to  the  nerv- 
ous system.  In  the  case  of  burrowing  parasites,  trichinae,  for 
example,  there  may  be  direct  stimulation.  A  contraction  of  a 
muscle  independent  of  nerve  control  while  such  control  exists, 
is  not  probable ;  that  is  while  the  muscle  has  all  the  nerve 
connections  intact  between  itself  and  the  simplest  kind  of  a 
nerve  center.  This  fact  compels  us  to  consider  all  contractions 
of  muscles  as  resulting  from  irritation  of  nerves,  not  of  muscles 
directly.  Motor  nerves  may  be  directly  stimulated  by  sub- 
luxated  bones,  cartilage  or  by  swelling,  thus  causing  the 
muscles  which  they  innervate  to  contract.  Muscular  con- 
tractions in  the  immediate  and  distant  areas  is  coincident  with 
all  subluxations.  As  a  result  of  chemical  and  thermal  stimuli 
sensory  nerves  will  pass  their  impressions  to  the  motor  side 
of  a  reflex  arc  and  thus  cause  muscular  contraction. 

Structural  Tissues  Affected  by  Muscular  Contraction. 

A  contracted  muscle  always  exerts  its  influence  on  movable 
structures,  bone,  cartilage,  tendon,  fascia,  skin ;  or  where 
muscle  forms  one  of  the  layers  of  a  hollow  organ  or  vessel 
contraction  lessens  the  caliber.  Lessened  size  of  blood  vessels 
means  lessened  nourishment  to  the  parts  supplied  by  those 
vessels.  Lessened  caliber  of  bronchioles  means  lessened  re- 
spiratory power,  hence  lessened  o.vygenation  of  the  blood. 
When  a  muscle  contracts  it  compresses  its  blood  capillaries 
and  raises  blood  pressure.  If  all  the  muscles  of  the  body  con- 
tract, as  in  violent  exercise,  blood  pressure  is  enormously 
increased  and  the  heart  is  put  to  a  severe  test.  The  relative 
effects  on  the  whole  circulation,  caused  by  the  contraction  of 
one  group  of  muscles  might  be  small  and  yet  be  very  detri- 
mental to  local  circulation  in  the  contracted  area.  Alternate 
relaxation  and  contraction  adds  strength  to  a  muscle,  but 
continuous  partial  contraction,  such  as  results  from  continued 
stimulation,  not  only  results  in  destroying  structural  align- 
ment but  injures  the  muscle  substance.  If  the  effects  were 
all  local,  little  attention  would  be  paid  to  them  but  they  es- 
tablish a  chain  of  reflexes  which  manifest  themselves  end- 
lessly. 


48  PEINCIPLES  OF  OSTEOPATHY. 

Circulation  of  Blood  in  Muscle. — A  comparison  of  the 
blood  which  enters  a  muscle  with  that  which  leaves  it  shows 
that,  whereas  the  former  is  bright  red,  contains  a  relatively 
large  amount  of  oxygen  and  small  amount  of  carbonic  acid 
gas,  the  latter  is  dark  blue  in  color  and  its  proportions  of 
oxygen  and  carbonic  acid  gas  are  the  reverse  of  the  former 
and  contains  other  ingredients  the  result  of  katabolism  in 
the  muscle  and  its  food ;  the  temperature  is  higher  in  the 
latter  than  in  the  former.  When  a  muscle  is  contracted  con- 
tinuously it  does  not  receive  its  full  amount  of  blood  and  this 
causes  lessened  irritability  of  the  muscle  substance,  the  same 
is  true  if  the  quality  of  the  blood  supplied  is  poor  or  the 
muscle  vein  is  obstructed  so  that  the  muscle  cannot  get  rid 
of  its  waste  products.  Restoration  of  irritability  may  be  se- 
cured by  removing  the  above  causes. 

Michael  Foster  has  well  stated  the  importance  of  the  mus- 
cular tissue  where  he  says  that  the  whole  of  the  rest  of  the 
body  is  engaged  "(0  in  so  preparing  the  raw  food,  and  so 
bringing  it  to  the  nervous  and  muscular  tissues,  that  these 
may  build  it  up  into  their  own  substance  with  the  least  trouble ; 
and  (2)  in  receiving  the  waste  matters  which  arise  in  mus- 
cular and  nervous  tissues  and  preparing  them  for  rapid  and 
easy  ejection  from  the  body." 

Effect  of  Contraction — Intrinsic. — The  intrinsic  effect 
of  continuous  muscular  contraction  is  lessened  activity  of  the 
muscle,  hence  lessened  inter-change  of  food  and  waste  products 
ending  in  decrease  of  muscle  substance. 

Extrinsic. — The  extrinsic  effect  is  principally  noted  in 
the  amount  of  heat  produced  and  the  pernicious  effect  on 
circulation,  both  locally  and  systemically.  Above  all,  to  the 
osteopath  the  nerve  reflexes  which  are  the  result  of  mechanical 
pressure  resulting  from  contraction  over  a  nerve  trunk,  or 
from  a  bone  subluxated  by  over-contraction  of  an  attached 
muscle,  are  most  interesting. 

Summary. — A  muscular  contraction  may  not  cause 
widespread  reflexes  unless  situated  so  as  to  mechanically  irri- 
tate the  nerve  trunk.  All  muscular  contractions  along  the 
spine  are  so  situated  that  they  may  be  considered  irritating 


PEIXCIPLES  OF  OSTEOPATHY.  49 

lesions,  whether  they  are  primary  or  secondary  needs  to  be 
determined  by  careful  physical  examination  and  history. 

We  pay  little  attention  to  the  intrinsic  effects  of  muscu- 
lar contraction  or  to  the  chemical  changes  in  the  blood  stream 
as  a  result  of  such  contraction.  The  structural  changes  with 
the  resulting  nerve  reflexes  are  what  we  are  most  interested 
in.  If  the  contraction  is  secondary  to  a  bony  lesion,  it  is 
frequently  treated  indirectly  through  reducing  the  subluxa- 
tion.  If  it  appears  to  be  primary,  treatment  may  be  applied 
to  it  directly  or  indirectly,  i.  e.,  by  direct  inhibitory  pressure, 
stretching,  inhibition  of  the  motor  nerve  or  thermally. 

Our  reasoning  concerning  these  lesions  again  follows 
from  perverted  structure  to  perverted  function  and  may  be 
stated  much  as  before:  The  lesion  is  an  obstruction  to  blood 
supply,  which  equals  a  changed  metabolism  in  the  immediate 
area,  resulting  in  irritation  to  the  nerves  in  the  immediate  area 
either  as  result  of  pressure  or  lack  of  proper  food.  This  is 
folloived  by  an  altered  blood  supply  in  distant  reflex  areas 
through  action  of  vaso  motor  nerves,  causing  changed  meta- 
bolism in  said  distant  or  rene.v  areas,  resulting  in  weakened 
tissue  through  lack  of  proper  exchange  of  food  and  waste 
elements.  This  decreases  resistance  to  bacteria,  hence  opens 
the  way  to  specific  infection. 


CHAPTER  III. 


IRRITABLE  TISSUE. 

A  masterful  knowledge  of  nerve  tissue  and  its  arrange- 
ment in  the  body  to  form  the  nervous  system  is  an  absolute 
prerequisite  for  success  in  osteopathic  practice.  Every  vital 
phenomenon  calls  for  interpretation  by  the  skillful  physician. 
Interpretation  cannot  be  attempted  without  a  definite  knowl- 
edge of  structure  and  function  of  that  tissue  which  acts  as  a 
medium  of  communication  between  all  other  elements  of  the 
body. 


5o  PEINCIPLES  OF   OSTEOPATHY. 

The  name  of  our  system,  Osteopathy,  calls  attention  pri- 
marily to  osseous  structure,  but  it  is  only  in  connection  with 


Fig.   10. — Pyramidal  and  Polymorphous  cells  from  the  cerebrum  of  a  man  60  years 
old.      Xiso.      a,   Polymorphous  cells;   b,   Pyramidal  cells. 

its  effects  on  the  tissues  of  communication  and  exchange,  vital 
phenomena,  we  are  actually  interested. 

All  physiological  phenomena  are  characterized  by  the 
manifestation  of  attributes  of  nerve  tissue,  irritability,  con- 
ductivity and  trophicity;  motion,  sensation  and  nutrition  are 
the  vital  phenomena  whose  perversion  constitutes  disease. 
Therefore  whatever  the  pathological  condition  may  be,  we  are 
called  upon  to  note  a  change  in  some  one  or  all  of  these  at- 
tributes of  nerve  tissue. 


PBINCIPLES  OF   OSTEOPATHY.  51 

We  cannot  proceed  farther  in  a  logical  manner  without 
frequent  references  to  the  special  attributes  of  irritable  tissue. 


Fig.    ii. — Photomicrograph    of   a    Purkinje    nerve   cell 
in  the  cerebellum,  human.     Golgi  preparation. 

We  will,  therefore,  devote  this  chapter  to  a  special  considera- 
tion of  these  attributes. 


Fig.     12. — Photomicrograph     of    multipolar     nerve    celFs     in     the     anterior     horns 
of  the   spinal   cord. 

Nerve   Tissue — Scarcely    any    thought    of    muscle   is 
ever  complete  without  the  nerve  impulse  which  controls  the 


52  PRINCIPLES  OF  OSTEOPATHY. 

muscle  is  also  considered.  For  convenience  sake  we  may 
separate  nerve  and  muscle  when  teaching  their  special  attri- 
butes but  for  all  practical  purposes  they  are  never  separated. 


Fig.   13. — Drawn  by  J.  E.   Stuart,  D.   O. 

The  elucidation  of  our  subject  requires  us  to  call  your 
attention  to  some  facts  in  physiology  of  nerve  tissue  which 
are  essential  to  the  foundation  of  our  system  of  therapeutics. 
The  nervous  system  consists  of  sending,  conducting  and  receiv- 
ing elements,  that  is,  cells,  fibers  and  end  organs.  It  is  the 
physiology  of  these  elements,  singly  and  en  masse,  which  is 
of  paramount  importance  in  osteopathic  diagnosis  and  thera- 
peutics. 

Irritability. — Muscle  and  nerve  are  both  irritable,  but 
we  pay  no  attention  to  the  irritability  of  muscle  because  un- 
der normal  conditions  we  do  not  see  any  evidences  of  specific 
muscular  irritability.  We  view  muscular  irritability  as  the 
result  of  nerve  irritability.  Therefore  nerve  tissue  is  the 
chief  irritable  tissue.  Irritability  is  an  attribute  of  cell  proto- 
plasm whereby  chemical  and  physical  phenomena  are  enacted 
in  response  to  irritants.  Irritants  may  be  mechanical,  chem- 
ical, thermal  and  electrical.  Practically  all  that  physiologists 
know  of  the  reactions  of  nerve  tissue  to  irritants  has  been  de- 
rived through  experimentation  by  means  of  the  electrical  cur- 
rent. Osteopathists  are  bringing  to  light  many  facts  con- 


PRINCIPLES   OF   OSTEOPATHY.  53 

cerning  mechanical  stimulation.  Hydro-therapists  have  dem- 
onstrated the  utility  of  thermal  stimuli.  Drug  therapy  makes 
use  of  the  chemical  form  of  stimulation. 

Conductivity. — Nerve  tissue  is  not  only  irritable  but 
possesses  the  ability  to  transmit  its  irritability  to  other  tissues 
and  cause  certain  activities  to  be  initiated  there.  Conductivity, 
the  second  vital  attribute  of  nerve  tissue,  is  the  power  to 
carry  impulses  from  the  point  of  irritation  to  other  points  in 
the  nervous  system.  Irritability  would  be  of  small  moment  if 
conductivity  were  not  present  to  transmit  the  message  to  the 
center  and  arouse  response. 

The  nerve  cell  and  its  axis-cylinder  are  a  continuous 
mass  of  protoplasm  and  as  long  as  the  continuity  is  maintained 
conductivity  will  be  maintained. 

Trophicity. — The  third  attribute  of  nerve  tissue,  tro- 
phicity,  is  very  imperfectly  understood.  We  do  not  use  this 
term  here  to  represent  so  much  the  nutritional  influences  of 
the  cell-body  over  its  axis-cylinder  as  the  influence-exerted 
by  nerve  tissue  over  other  body  tissues,  causing  them  to 
grow  and  prosper.  This  nutritional  influence  over  other  tis- 
sues is  an  attribute  which  we  are  compelled  to  note  quite  fre- 
quently in  practice.  There  are  individuals  in  whom  motion 
and  sensation  are  normal  but  nutrition  fails,  hence  we  note 
that  in  some  cases  mechanical  lesions  may  cause  only  a 
slight  change  in  the  nerve  tissue  upon  which  it  infringes,  and 
this  change  is  manifested  by  variation  in  nutrition  of  the  part 
controlled  by  the  irritated  nerve.  It  is  probably  this  attri- 
bute of  nerve  tissue  which  is  perverted  or  lost  when  the  tis- 
sues refuse  to  take  up  certain  chemical  elements  which  are 
ordinarily  normal  to  them ;  for  example,  iron. 

In  osteopathic  practice  we  consider  nutritional  disorders 
as  being  the  result  of  perverted  trophic  influence  of  nerves. 
Of  course  in  cases  where  it  is  known  that  the  ingested  food 
does  not  contain  the  required  element  or  elements  we  must 
regulate  the  diet.  But  there  are  many  cases  where  all  con- 
ditions appear  normal  except  that  the  tissues  do  not  take  up 
nourishment  as  they  should.  In  these  cases  we  search  for 
lesions  in  the  same  way  we  would  if  motion  or  sensation 


54  PRINCIPLES  OF  OSTEOPATHY. 

showed  perversion  or  loss.  This  phase  of  our  subject  can 
best  be  considered  at  another  time. 

Unity  of  the  Nervous  System. — The  unity  of  the  ner- 
vous system  is  a  physiological  fact,  and  this  brings  deep  and 
superficial  areas  in  close  relation.  Every  portion  of  the  body 
is  able  through  the  medium  of  the  nervous  system  to  work 
in  harmony  with  every  other  part. 

Physiologists  divide  the  nervous  system  into  central  and 
peripheral  portions,  but  for  practical  purposes  this  division 
is  of  little  use  to  us  when  attempting  to  make  use  of  the  irri- 
tability and  conductivity  of  the  nervous  system  for  thera- 
peutic purposes. 

Since  all  portions  of  the  nervous  system  are  connected 
there  must  be  some  place  where  impressions  made  upon  ter- 
minal nerve  filaments  may  be  assembled,  co-ordinated  and  re- 
sponded to  harmoniously.  Wherever  large  numbers  of  nerve 
cells  are  assembled  we  expect  to  find  such  duties  performed. 

Mechanical  Irritation. — We  have  noted  in  the  previous 
lecture  that  mechanical  pressure  made  upon  nerve  fibers  by 
subluxated  bone  or  cartilage,  contracted  muscle  or  thickened 
ligament  will  set  up  changes  in  the  protoplasm  of  nerve  tissue. 
"Mechanical  applications  to  nerve  and  muscle  first  increase 
and  later  lessen  and  destroy  the  irritability.  Thus  pressure 
gradually  applied  first  increases  and  later  reduces  the  power 
to  respond  to  irritants."  (Lombard,  in  American  Text-Book 
of  Physiology.)  These  structural  displacements  in  the  human 
body  act  as  mechanical  irritants  to  nerve  tissue  changing  the 
chemical  and  physical  condition  of  the  protoplasm  and  thus 
altering  its  irritability,  either  plus  or  minus  according  to  the 
intensity  of  the  stimulation.  The  displaced  structures  may 
have  other  detrimental  influences  on  nerve  tissue,  for  in- 
stance the  pressure  brought  to  bear  on  the  nourishing  liquids 
surrounding  the  nerve,  i.  e.  the  blood  and  lymph,  may  cause 
sufficient  chemical  change  in  these  liquids  to  materially  affect 
irritability  of  the  protoplasm  of  the  nerves  which  they  are 
expected  to  nourish. 

Conductivity  is  not  destroyed  by  these  slight  mechanical 
pressures.  If  the  protoplasm  of  the  cell  and  axis-cylinder 


PEIXCIPLES  OF  OSTEOPATHY.  55 

were  unable  to  conduct  impulses  and  project  them  in  such 
manner  as  to  reach  other  cell  bodies  of  the  nervous  system 
our  work  would  be  very  limited.  Conductivity  depends  on 
the  continuity  of  protoplasm.  The  mechanical  irritations  we 
deal  with  in  osteopathic  practice  seldom  destroy  conductivity. 
If  they  did  do  so,  they  would  cease  to  be  irritants  the  moment 
conductivity  was  lost.  Other  irritants  may  act  for  a  time  on 
the  severed  portions  of  protoplasm  but  the  original  lesion 
would  have  destroyed  the  continuity  of  the  protoplasm. 

Double  Conduction. — Double  conduction  is  another 
physiological  fact  which  explains  to  some  extent  the  results 
observed  in  osteopathic  practice  when  pressure  is  made  over 
nerve  bundles ;  but  the  complexity  of  fibers  in  the  nerve 
bundle  makes  it  impossible  to  say  positively  whether  the  cen- 
tral and  peripheral  phenomena  are  the  results  of  double  con- 
duction or  the  presence  of  afferent  and  efferent  fibers.  Since 
we  know  that  nerve  bundles  are  made  up  of  both  afferent  and 
efferent  fibers  there  is  no  particular  need  for  us  to  explain 
results  by  double  conduction. 

Nerve  Bundles. — We  have  been  dealing  thus  far  with 
irritability  and  conductivity  as  attributes  of  nerve  tissue.  In 
a  general  way  we  have  viewed  the  results  of  mechanical 
pressure  on  a  solitary  nerve  fiber,  not  caring  whether  it  is 
afferent  or  efferent  or  what  its  function.  The  next  step  is 
the  consideration  of  nerve  bundles.  The  fibers  composing  a 
nerve  bundle  may  be  efferent  or  afferent  so  far  as  direction 
of  impulse  is  concerned.  Efferent  fibers  may  be  further  dif- 
ferentiated by  the  names,  motor,  vaso-motor,  secretory  ac- 
cording to  the  structures  in  which  they  end.  Afferent  fibers 
are  usually  termed  sensory  to  denote  their  function  of  car- 
rying impulses  to  the  central  nervous  system.  Nerve  trunks 
•contain  all  of  these  various  fibers,  therefore,  pressure  will 
irritate  all  of  the  fibers  and  conductivity  of  individual  fibers 
will  transmit  the  impulses  in  the  direction  of  the  normal  nerve 
impulse,  thus  causing  contraction  in  the  voluntary  or  involun- 
tary muscles  or  activity  of  secretory  tissues;  sensory  impulses 
will  be  transmitted  to  the  central  nervous  system  and  will  pur- 
port to  come  from  the  terminal  distribution  of  the  sensorv 


56  PKINCIPLES  OF  OSTEOPATHY. 

nerve.  If  the  afferent  impulse  is  such  an  one  as  will  reach 
the  patient's  consciousness,  we  find  that  the  central  cells  are 
misled  as  to  the  location  of  the  stimulus  and  hence  manifest 
a  response  in  the  supposed  area.  It  is  not  necessary  for  the 
patient  to  be  conscious  of  any  irritation  in  order  to  bring  about 
this  result. 

The  Central  Nervous  System. — The  organization  of 
the  nerve  bundle  complicates  our  ideas  of  irritability  and  con- 
ductivity in  the  protoplasm  of  the  cell  and  axis-cylinder  of  a 
nervous  unit.  Complexity  of  action  and  reaction  increases  as 
we  near  the  central  nervous  system.  We  have  considered  that 
all  impulses  generated  in  the  protoplasm  of  a  nerve  cell  and 
axis-cylinder  have  been  transmitted  to  all  parts  of  that  unit 
of  nerve  tissue,  but  has  not  in  any  way  influenced  any  other 
unit.  We  have  not  considered  the  relations  of  cell  bodies  in 
the  central  system.  It  is  sufficient  for  our  present  purpose 
to  note  that  the  afferent  fibers  enter  the  spinal  cord  as  the 
posterior  roots  and  that  their  cells  are  in  the  ganglia  of  these 
posterior  roots. 

The  efferent  fibers  leave  the  cord  as  its  anterior  roots  and 
their  cell  bodies  are  located  in  the  anterior  cornua  of  the  gray 
matter  of  the  cord.  Upon  careful  study  of  the  spinal  cord 
there  are  found  other  cells  and  axis-cylinders  which  do  not 
leave  the  cord  but  serve  to  connect  the  afferent  and  efferent  ele- 
ments and  distribute  impulses  within  the  cord.  These  latter 
are  found  in  enormous  numbers  in  all  portions  of  the  central 
nervous  system. 

Segmentation. — The  first  fact  of  great  interest  to  us 
osteopathically,  is  the  segmentation  of  the  spinal  cord.  This 
is  only  relative  in  character,  but  yet  is  apparent  not  only  his- 
tologically,  but  pathologically.  We  note  that  according  to  dis- 
tribution of  afferent  fibers  in  the  spinal  cord  impulses  are  dif- 
fused both  above  and  below  the  point  of  entrance.  The  cell 
bodies  of  the  anterior  roots  are  also  somewhat  diffused,  but  in 
practice  we  note  that  afferent  and  efferent  impulses  seem  to  be 
correlated  within  comparatively  narrow  limits  in  the  spinal  cord. 
How  the  impulses  set  up  in  the  protoplasm  of  an  afferent 
fiber  are  transmitted  from  it  to  the  protoplasm  of  other  cells 


PRIXCIPLKS   OF  OSTEOPATHY. 


57 


Fig.  14.— Camera  lucida  drawing  of  a  golgi  preparation,  made  by  J.  E.  Stuart,  D.  O. 


Fig.   i5.-Photomicrograph   of  a  cross-section  of  the  spinal  cord.   Golgi  preparation. 
Photographed  by  J.  O.  Hunt,  D.  O. 


58  PRINCIPLES  OF  OSTEOPATHY. 

located  in  the  spinal  cord  and  thence  transmitted  to  the  pro- 
toplasm of  efferent  cells  is  not  known,  nor  is  it  necessary  for 
us  to  thoroughly  understand  the  method  in  this  instance  so 
long  as  we  recognize  the  results.  Our  specific  knowledge  must 
comprehend  the  exact  point  of  entrance  to  and  exit  from  the 
spinal  cord  of  each  nerve  bundle  and  the  peripheral  distribu- 
tion of  the  same.  Having  a  knowledge  of  the  structure,  the 
function  comes  naturally  as  a  result. 

Segmentation  refers  to  structure,  and  thus  the  next  point, 
reflex  action,  which  is  physiological,  is  a  logical  sequence. 

Reflex   Action. — The   central   nervous   system   is   con- 


Fig.   1 6. — Drawn  by  J.  E).   Stuart,  D.  O. 

stantly  receiving  impulses  from  afferent  fibers  and  co-ordinat- 
ing them.  We  are  almost  entirely  dependent  on  reflex  action 
for  the  effects  we  secure  on  deep  tissues.  Our  manipulations 
affect  sensory  nerves  in  skin,  muscle  and  synovial  membrane. 
These  impulses  are  carried  to  the  central  nervous  system  and 
transformed  into  efferent  impulses. 

During  life  there  is  no  period  when  the  body  is  not  de- 


PEINCIPLES  OF  OSTEOPATHY.  59 

pendent  on  external  stimuli.  These  ordinary  mechanical  and 
thermal  stimuli  keep  a  constant  stream  of  impulses  entering 
the  central  system  to  be  translated  into  stimuli  of  muscle  and 
gland.  This  ceaseless  play  of  reflexes  may  vary  in  intensity, 
but  so  long  as  life  lasts  they  are  demonstrable.  We  expect 
the  reflex  to  be  initiated  by  the  sensory  side  of  the  reflex  arc, 
therefore  the  intensity  of  muscular  contraction  and  glandular 
secretion  is  governed  by  the  intensity  of  the  initiatory  impulse. 
This  is  certainly  the  case  under  normal  conditions,  but  in  the 
case  of  a  subluxation,  muscular  contraction  and  secretory  ac- 
tivity in  the  area  of  distribution  of  an  irritated  nerve  trunk 
may  be  increased  primarily,  i.  e.,  without  the  initiatory  im- 
pulse being  originated  in  a  sensory  nerve.  The  pressure  on 
the  efferent  fibers  to  muscle  and  gland  stimulates  them  with- 
out the  intervention  of  the  central  nervous  system.  Our 
methods  of  diagnosis  take  into  consideration  both  the  me- 
chanical lesions  which  cause  direct  stimulation  of  a  nerve 
trunk,  and  those  pathological  conditions  which  are  the  result 
of  intensified  normal  stimuli. 

Practical  Application.—  The  segmented  structure  of  the 
cord  and  the  reflex  action  manifested  therein  show  that  on  the 
zvhole,  a  definite  muscle  group  and  a  definite  cutaneous  area 
are  innervated  from,  a  limited  portion  of  the  central  system. 
Therefore  we  may  count  on  the  stimuli  originated  in  the  cuta- 
neous area  being  reflexed  to  the  definite  muscular  area. 

An  example  in  practice  is  as  follows:  patient's  head  is 
drawn  slightly  to  the  left  side.  Complains  of  pain  shooting 
to  the  left  shoulder  and  over  the  left  clavicle  whenever  move- 
ment is  attempted.  History  of  exposure  to  draught  of  cold 
air.  Physical  examination  discloses  contraction  of  left  trape- 
zius,  levator  anguli  scapulae  and  scaleni.  Pressure  upon  these 
muscles  causes  pain.  When  instructed  to  take  a  full  inspira- 
tion, patient  says  he  can  not  on  account  of  pain  which  is  sharp 
and  darting  in  character  and  radiates  over  the  infraclavicular 
portion  of  the  left  chest.  When  we  consider  the  muscles  in- 
volved and  the  area  of  painful  sensations  our  attention  is  im- 
mediately called  to  a  definite  segment  of  the  cord,  in  this  case 
the  point  of  origin  of  the  third  and  fourth  cervical  nerves. 


60  PKINCIPLES  OF  OSTEOPATHY. 

The  cold  air  striking  the  skin,  intensified  the  normal  stimuli, 
and  the  efferent  impulses  from  that  segment  of  the  cord  were 
intensified  as  the  direct  result  of  the  cutaneous  irritation.  The 
point  of  irritation,  the  cutaneous  area,  governed  the  location 
of  the  reflex.  So  long  as  the  original  stimulus  was  only  mod- 
erately intensified  all  the  reflexes  emanate  from  one  segment 
of  the  cord,  but  if  they  had  been  more  intense  or  continued 
longer,  we  might  have  found  a  greater  area  reflexly  affected. 
The  stimuli  which  would  have  reached  the  cord  would  have 
been  more  widely  diffused  above  and  below  the  point  of  en- 
trance. 

Since  we  know  that  the  highly  organized  spinal  cord  of 
man  is  not  to  be  compared  with  the  same  structure  in  lower 
forms  of  animal  life,  and  that  segmentation  in  it  is  illy  de- 
fined, the  practical  question  arises  as  to  how  much  dependence 
we  can  put  upon  reflexes  in  the  human  nervous  system.  Will 
the  reflexes  guide  us  to  definite  segments  of  the  spinal  cord? 
Experience  teaches  us  that  a  thorough  knowledge  of  the  dis- 
tribution of  afferent  and  efferent  nerves  in  man  will  interpret 
reflexes  with  sufficient  exactness  and  invariably  lead  the  in- 
vestigator to  a  spinal  segment  which  is  itself  affected  or  is  co- 
ordinating impulses  from  a  known  sensory  area. 

Efferent  Fibers. — When  we  follow  the  efferent  im- 
pulses to  their  points  of  distribution  our  work  is  greatly  com- 
plicated. To  reason  from  contracted  voluntary  muscle  to  cu- 
taneous sensory  area  is  a  comparatively  simple  procedure; 
but  to  start  with  the  sensory  impulse  and  trace  it  through 
the  central  system,  and  thence  along  efferent  pathways,  to  esti- 
mate its  final  effects  as  mechanical  work  done  by  muscle  and 
gland  in  many  combinations,  requires  a  considerable  knowl- 
edge of  structure  and  function  of  all  parts  of  the  human 
system. 

Many  of  the  efferent  fibers  of  the  cerebro-spinal  system 
take  their  course  through  the  sympathetic  ganglia  and  are 
distributed  in  that  system  to  plain  muscle  and  secretory  cells 
of  the  body.  It  has  been  ascertained  by  various  careful  ob- 
servers that  these  efferent  fibers,  after  entering  the  sympa- 
thetic system,  either  end  in  the  ganglia  nearest  their  point  of 


PEIXCIPLES   OF   OSTEOPATHY.  61 

emergence  from  the  cord  or  pass  up  or  down  to  ganglia  above 
or  below  the  one  originally  entered.  Some  fibers  pass  through 
these  ganglia  and  end  in  the  more  peripherally  placed  plex- 
uses. 

Sympathetic  Ganglia. — Wherever  nerve  cells  are  accu- 
mulated a  certain  amount  of  independent  action  is  probably 
carried  on.  Terminal  filaments  of  efferent  fibers  in  sympa- 
thetic spinal  ganglia  are  in  relation  with  a  large  number  of 
cells  and  the  number  of  fibers  leaving  the  ganglion  is  greater 
than  those  entering.  Therefore  diffusion  of  impulses  from 
these  ganglia  must  be  very  great.  The  accumulation  of  sen- 
sory impulses  in  these  ganglia  may  be  equally  as  great.  Each 
ganglion  must  have  a  dominant  influence  over  a  certain  vis- 
ceral area,  and  this  influence  is  subsidiary  to  the  control  ex- 
ercised by  the  segment  of  spinal  cord  to  and  from  which  the 
larger  number  of  its  fibers  proceed. 

Diagnosis — Objective  Symptoms. — Osteopaths  have 
in  great  measure  discarded  subjective  symptoms,  believing 
that  they  are  of  very  doubtful  value  in  the  large  proportion 
of  patients.  Having  discarded  subjective  symptoms,  they 
have  developed  a  method  which  gives  equal  or  better  re- 
sults. It  has  three  phases,  two  of  which  are  structural  and 
one  which  is  partially  subjective.  First  in  order  comes,  skel- 
etal alignment;  second,  muscular  tone;  third,  condition  of 
reflexes.  These  three  divisions  all  come  under  the  general 
head  of  palpation. 

As  an  illustration  of  the  value  of  objective  in  preference 
to  subjective  symptoms,  the  following  case  is  of  considerable 
value.  The  gentleman  whose  physical  condition  is  practically 
illustrated  in  Figs.  17  and  18  was  examined  in  the  clinic  of 
the  Pacific  School  of  Osteopathy.  He  had  been  operated 
on  surgically  for  a  peculiar  enlargement  just  above  and  ex- 
ternal to  the  right  knee.  The  line  of  the  incision  is  shown 
in  Fig.  17.  He  stated  that  he  had  suffered  pain  at  this  point 
during  more  than  a  year,  and  his  physician  had  decided  that 
there  was  a  tuberculous  condition  of  the  bone.  The  operation 
did  not  confirm  this  diagnosis.  No  unhealthy  tissue  was 
found. 


PEINCIPLES  OF  OSTEOPATHY. 


Fig.  17. — Photograph  of  a  c-ase  illustrating  atrophy  of  the  muscles  of  the  right  leg 
due  to  faulty  trophic  influence  of  the  nerve  cells  in  the  spinal  cord.  The  scar 
just  above  the  right  patella  is  superficial  to  a  hypertrophic  condition  of  the  bone. 


PRINCIPLES  OF   OSTEOPATHY.  63 

We  noted  his  peculiar  handling  of  the  leg  when  walking, 
compared  both  limbs  from  toe  to  hip  and  discovered  a  marked 
difference  in  size,  as  is  indicated  in  the  photograph.  By  fol- 
lowing the  course  of  the  nerves  to  the  spinal  column,  we  dis- 
covered that  the  muscles  on  the  right  side  of  the  spine  were 
atrophied  in  proportion  to  those  of  the  extremity.  Fig.  18 
shows  the  fact  that  the  atrophied  condition  extends  into  the 
interscapular  region,  and  the  spinal  column  is  bent. 

The  patellar  tendon  reflex  was  lost  on  the  right  side,  but 
present  on  the  left.  The  right  leg  was  ataxic,  but  the  left 
leg  was  normal,  thus  presenting  what  might  be  called  a  uni- 
lateral locomotor  ataxia.  If  this  man's  surgeon  had  taken 
the  care  to  examine  him  from  an  objective  structural  stand- 
point rather  than  to  depend  on  the  subjective  symptoms,  it  is 
highly  probable  that  no  operation  would  have  been  performed. 
Our  examination  demonstrated  that  this  man's  structural  con- 
dition was  at  fault,  and  that  the  trophic  influence  of  a  part  of 
his  nervous  system  was  being  gradually  lost.  Both  the  motor 
and  sensory  nerves  were  acting  feebly. 

It  might  be  asked,  "How  could  one  secure  a  spinal  reflex 
from  the  stomach?"  In  what  way  would  the  finding  of  such 
a  reflex  surpass  ordinary  methods  of  examination? 

The  neurologist,  when  making  examination  of  a  patient 
suffering  with  some  faulty  condition  of  the  sensory  or  motor 
portion  of  the  nervous  system,  must  possess  a  definite  knowl- 
edge of  the  origin,  course  and  distribution  of  nerve  trunks  in 
order  to  locate  accurately  the  position  of  the  lesion.  The 
osteopath  pursues  the  same  method  of  examination,  but  fol- 
lows it  farther.  His  investigation  takes  into  consideration 
the  dispersion  of  efferent  fibers  in  the  sympathetic  system 
and  the  sensory  impulses  received  from  the  spinal  cord  from 
that  system. 

Edinger  quotes  Exner  as  follows :  "One  must  not  sup- 
pose that  all  the  impulses  reaching  the  spinal  cord  by  the 
sensory  roots  are  identical  with  what  is  ordinarily  called  'sen- 
sation.' In  order  that  an  impression  be  perceived,  it  is  not 
sufficient  that  it  be  conducted  to  the  spinal  cord,  but  it  must 
be  farther  carried  up,  from  the  place  where  the  peripheral 


PRINCIPLES  OF  OSTEOPATHY. 


Fig.  1 8. — General  view  of  case  illustrated  in  the 
preceding;  figure.  The  spinal  curvature  is 
clearly  indicated.  Patellar  tendon  reflex  ab- 
sent on  right  side  but  present  on  the  left. 


PEINCIPLES  OF  OSTEOPATHY.  65 

part  ends,  to  the  cerebral  cortex.  There  is,  however,  no  doubt 
at  all  that  all  these  higher  connections  are  few  in  number,  and 
that  contrasted  with  the  multitude  of  fibers  in  the  posterior 
roots,  the  number  of  such  cranial  connections  is  quite  small. 
This  alone  makes  the  conclusion  possible  that  there  are,  in- 
deed, many  sensory  impressions  which  arrive  at  the  spinal 
cord,  but  that  we  are  aware  of  but  few  of  them  at  the  time. 
All  the  viscera  of  the  body,  as  the  staining  method  has  dis- 
tinctly shown,  are  traversed  by  an  altogether  unexpectedly 
large  number  of  nerves,  and  their  arrangement  and  course, 
their  relations  to  blood  vessels  and  glands,  and  to  muscle 
fibers,  bones,  and  enamel  makes  it  more  than  probable  that 
there  is,  in  this  connection,  a  large  system  which  serves  es- 
sentially to  regulate  impressions  and  reflex  action."  Anatomy 
of  the  Central  Nervous  System  of  Man  and  of  Vertebrates  in 
General. — Edinger. 

Co-ordination  of  Sensations. — It  is  the  reflexes  men- 
tioned in  this  quotation  in  which  we  are  interested.  Sensa- 
tion and  perception  are  dissimilar.  Sensations  from  the  vis- 
cera are  co-ordinated  in  fairly  well-marked  areas  of  the  spinal 
cord,  and  when  these  sensory  impressions  are  intense  the  ef- 
ferent fibers  of  the  spinal  cord  manifest  the  condition  exist- 
ing in  a  visceral  area  by  causing  an  abnormal  condition  of 
muscular  tone  in  the  intrinsic  muscles  of  the  back.  This  con- 
tractured  condition  of  the  muscles  is  not  the  only  evidence 
of  the  visceral  reflex.  Pressure  on  the  contracted  muscle 
causes  pain.  The  intensity  of  the  aesthesia  is  usually  in  pro- 
portion to  the  visceral  irritation.  Even  though  the  patient 
does  not  say  in  so  many  words  that  there  is  pain  on  slight 
pressure,  the  examiner,  if  his  palpation  is  good,  can  detect 
the  reflex  in  the  action  of  the  muscle. 

Example. — A  patient  comes  to  an  osteopath  desiring 
to  be  examined.  He  does  not  vouchsafe  any  information  as 
to  his  condition,  merely  saying,  "I  want  you  to  examine  me 
and  find  out  what  is  the  matter  with  me."  This  is  a  chal- 
lenge to  the  skill  of  the  examiner  and  calls  for  something  be- 
sides a  long-distance  catechising  as  to  subjective  feelings. 
The  osteopath  proceeds  with  absolute  precision  to  determine 


66  PRINCIPLES  OF  OSTEOPATHY. 

the  condition  of  his  patient's  structural  formation,  (i)  Skel- 
etal alignment,  (2)  muscular  tone,  and  (3)  segmental  spinal 
reflex.  Each  yields  valuable  information.  The  examiner's 
fingers  may  develop  a  reflex  around  the  sixth  dorsal  spine. 
This  is  noted  as  a  reflex  from  the  gastric  area.  Testing  the 
segments  above  and  below  this  will  show  how  great  a  section 
of  the  cord  is  irritated  and  will  be  an  indication  of  the  extent 
of  the  internal  irritation,  i.  e.,  whether  other  portions  of  the 
digestive  tract  are  affected.  The  reflex  might  extend  as  far 
as  the  fourth  dorsal  and  still  indicate  the  gastric  area.  Find- 
ing the  reflex  at  the  sixth  dorsal  spine  has  directed  the  attention 
of  the  examiner  to  the  gastric  area  and  has  located  a  point 
from  which  further  examination  is  to  proceed.  Percussion 
over  the  stomach  would  reveal  Other  facts,  and  then  the  ex- 
amination would  be  pursued  along  general  lines  of  physical 
diagnosis  to  determine  the  character  of  the  gastric  disorder. 

The  moment  the  examiner  centers  his  examination  on 
the  stomach,  the  confidence  of  the  patient  is  assured.  Is 
not  this  confidence  greatly  to  be  desired  in  every  case?  Is 
it  not  a  force  which  compels  the  patient  to  follow  the  direc- 
tions of  his  physician  in  matters  of  diet  and  hygiene? 

In  this  example  we  have  illustrated  the  attributes  of  nerve 
tissue,  (i)  irritability,  (2)  conductivity.  Other  conditions 
which  make  this  illustration  possible  are  (i)  muscular  con- 
traction in  response  to  nerve  stimulation,  (2)  segmentation 
of  the  spinal  cord,  (3)  reflex  action. 

We  have  added  nothing  new  to  the  world's  knowledge 
of  nerve  tissue,  but  we  have  applied  general  knowledge  of  this 
tissue  to  specific  uses.  We  have  taken  the  results  of  labora- 
tory experiments  and  made  them  practical  methods  in  the 
detection  and  alleviation  of  disease.  It  appears  to  us  that 
sufficient  research  work  has  been  done  on  the  nervous  sys- 
tem by  medical  men  and  sufficient  general  conclusions  drawn 
from  their  investigations  to  justify  all  branches  of  the  pro- 
fession in  making  more  extensive  use  of  such  data.  The 
correlation  of  laboratory  data  with  the  results  of  clinical  ex- 
perience make  the  foundation  of  osteopathic  diagnosis  at  the 
present  time.  By  this  bold  application  of  knowledge,  which 


PKINCIPLES  OF  OSTEOPATHY.  67 

to  the  medical  profession  at  large  has  been  regarded  as  specu- 
lative and  at  least  impracticable,  osteopathy  has  gained  an 
impregnable  position  in  the  healing  arts. 

Laboratories  make  scientists,  not  physicians ;  hence  phy- 
sicians have  not  always  grasped  the  full  significance  of  the 
scientific  discoveries  in  physiology  and  applied  them  to  thera- 
peutics. 

Whatever  osteopathy  may  at  present  possess  or  gain  in 
the  future,  is  due  solely  to  a  close  adherence  to  the  facts  of 
anatomy  and  physiology;  and  the  application  of  these  funda- 
mental facts  to  scientific  therapeutics. 


CHAPTER    IV. 


CIRCULATORY   TISSUE. 

From  the  histological  standpoint,  blood  conforms  to  the 
general  definition  of  a  tissue,  being  composed  of  a  cellular 
and  intercellular  substance.  The  intercellular  substance  being 
liquid,  differentiates  it  greatly  from  other  tissues.  It  con- 
tains cellular  elements  which  differ  from  each  other  in  form 
and  function.  Then,  too,  it  is  a  moving  tissue  enclosed  in  a 
system  of  closed  tubes. 

Functions. — The  blood  performs  many  functions. 
These  may  be  stated  in  general  terms  as  follows : 

1.  To  convey  nutrition  to  all  other  tissues. 

2.  To  remove  waste  products  from  the  tissues. 

3.  To  convey  oxygen  for  tissue  respiration. 

4.  To  distribute  heat. 

5.  To  repel  invasion  of  bacteria. 

Lymph. — Lymph  is  another  liquid  tissue,  less  rich  in 
corpuscular  elements,  but  greater  in  total  bulk  than  the  blood. 
The  lymph  comes  in  direct  contact  with  the  elements  of  the 


68  PRINCIPLES  OF  OSTEOPATHY. 

tissues.  Stewart  states  the  relationship  tersely  where  he  says, 
"The  blood  feeds  the  lymph  and  the  lymph  feeds  the  cell." 

Since  we  think  of  individual  tissues  as  possessing  some 
one  well  developed  attribute  or  function,  it  is  well  to  call  blood 
and  its  congener,  lymph,  the  media  of  exchange.  This  ex- 
pression covers  at  least  four  of  the  functions  previously  men- 
tioned. 

With  this  comprehensive  but  short  statement  of  the  re- 
lation of  these  liquid  tissues  to  the  structural,  contractile,  irri- 
table and  secretory  tissues,  it  seems  hardly  necessary  to  dis- 
cuss so  self-evident  a  proposition  as  that  health  primarily  de- 
pends on  a  perfect  circulation.  It  is  not  even  necessary  to  add 
to  this  the  fact  that  the  blood  should  be  pure,  because  under  or- 
dinary circumstances  if  the  blood  circulates  properly  it  will  be- 
come purified. 

All  schools  of  medicine  have  a  therapeutic  principle 
around  which  their  practice  is  built.  From  its  earliest  incep- 
tion the  osteopathic  idea  has  been  that  a  perfect  circulation 
is  the  foundation  for  perfect  health. 

Blood. — We  will  attempt  to  outline  the  general  prop- 
erties of  the  blood,  and  thus  state  the  basic  facts  of  the  chem- 
istry, histology  and  physiology  of  this  tissue,  which  plays 
such  an  important  part  in  osteopathic  therapeutics. 

Its  color  in  the  arteries  is  bright  red,  and  in  the  veins  is 
bluish  purple.  The  difference  in  color  is  due  to  the  relative 
amount  of  oxygen  and  carbon  dioxide  present  in  each.  Ar- 
terial blood  has  more  oxygen  and  less  carbon  dioxide,  more 
extractives,  salts  and  sugar,  and  less  urea  than  venous  blood. 
Arterial  blood  is  usually  warmer  than  venous.  It  is  changed 
to  a  darker  color  when  respiration  is  imperfect,  or  when  the 
individual  is  subjected  to  a  higher  temperature.  Venous  blood 
becomes  brighter  when  the  individual  is  made  to  breathe  pure 
oxygen.  It  is  also  brighter  in  the  veins  which  drain  an  act- 
ively secreting  gland  or  resting  muscle.  The  temperature 
varies  according  to  the  location,  that  in  the  hepatic  vein  be- 
ing the  warmest.  The  blood  in  the  visceral  is  warmer  than 
that  in  the  cutaneous  vessels. 

The  proportion  of  blood  to  body  weight  is  about  one- 


PRINCIPLES   OF  OSTEOPATHY.  69 

twelfth  of  the  whole,  i.  e.,  twelve  pounds  of  blood  in  a  body 
weighing  150  pounds.  This  amount  of  blood  is  distributed 
approximately  as  follows :  One-fourth  to  the  heart,  lungs  and 
great  blood-vessels ;  one-fourth  to  the  liver ;  one-fourth  to  the 
resting  muscles ;  one-fourth  to  the  remaining  organs."  There 
is  not  blood  enough  in  the  body  to  maintain  all  of  its  activities 
at  the  maximum  at  the  same  time.  Therefore  it  is  difficult  to  do 
the  best  physical  or  mental  labor  just  after  digestion  has  be- 
gun. The  splanchnic  blood  vessels  are  capable  of  containing 
so  large  a  proportion  of  the  whole  amount  of  blood  that  death 
may  result  from  lack  of  sufficient  blood  returning  to  the  heart 
to  cause  it  to  beat. 

Blood  Corpuscles,  Red. — The  physical  constituents  of 
the  blood  are  the  red  and  white  corpuscles  and  platelets. 

The  red  blood  corpuscles  are  the  oxygen  carriers.  It  is 
estimated  that  the  combined  surface  of  the  corpuscles  con- 
tained in  five  litres  of  blood  would  be  2,816  square  meters, 
i.  e.,  over  one-half  acre.  These  cells  retain  a  special  form 
but  possess  sufficient  elasticity  to  allow  them  to  pass  through 
capillaries  of  a  diameter  less  than  their  own,  and  then  assume 
their  normal  contour.  They  are  quickly  changed  in  appear- 
ance by  a  change  in  the  specific  gravity  of  their  surrounding 
media.  As  before  stated,  the  red  corpuscles  are  the  oxygen 
carriers.  Their  function  depends  on  the  presence  of  a  sub- 
stance called  haemoglobin,  which  unites  readily  with  oxygen 
to  form  oxyhaemoglobin.  Haemoglobin  is  a  very  complex 
substance,  containing  carbon,  nitrogen,  sulphur,  iron  and  ox- 
ygen. 

It  is  commonly  estimated  that  one  cubic  millimeter  con- 
tains 5,000,000  red  corpuscles.  This  number  varies  accord- 
ing to  age,  sex,  nutrition,  and  altitude. 

Investigations  seem  to  prove  that  these  cells  are  derived 
from  the  red  marrow  of  bone  and  end  their  life  in  the  spleen 
and  liver. 

White  Blood  Corpuscles. — White  blood  corpuscles 
have  been  known  since  1770.  They  are  far  less  numerous 
than  the  red  corpuscles,  colorless,  and  some  of  them  possess 
amoeboid  motion.  There  are  several  varieties,  grouped  ac- 


70  PKINCIPLES  OF  OSTEOPATHY. 

cording  to  staining  reaction  or  microscopic  structure.  Not  all 
possess  amoeboid  motion.  Probably  seventy  per  cent  have 
well  defined  power  of  movement. 

"It  is  indeed  a  question  if  the  different  forms  of  leuco- 
cytes are  distinctive  histological  elements  having  independent 
origins  and  functions,  or  whether  they  do  not,  after  all,  rep- 
resent different  stages  in  the  development  of  a  single  cell, 
the  lymphocytes  representing  an  early,  and  the  polynucleated 
leucocytes  the  last  stages." 

The  leucocytes  are  present  in  the  blood  in  proportion  to 
the  red  blood  corpuscles  about  one  to  five  hundred.  Their 
number  increases  "after  digestion,  hemorrhages,  pregnancy, 
in  diseases  in  which  suppuration  occurs,  and  in  leucocythae- 
mia."  Fasting  decreases  their  number. 

"Leucocytes  are  more  numerous  in  the  capillaries  and 
veins  of  the  spleen,  liver,  glands  and  intestinal  mucosa  than 
in  the  corresponding  vessels  of  the  skin,  muscles,  and  general 
cellular  tissues." 

The  functions  of  these  cells  are  many  and  varied.  A 
white  blood  corpuscle  may  be  considered  as  an  unmodified 
cell  retaining  all  attributes  of  the  amoeba.  Because  of  its 
independent  movement,  observers  have  called  it  a  "wander- 
ing cell."  They  have  the  power  to  enter  all  tissues,  passing 
from  the  plasma  through  the  vessel-wall  into  the  perivascular 
tissue.  They  re-enter  the  blood  current  with  the  lymph.  This 
process  of  migrating  is  continually  going  on,  but  is  greatly  in- 
creased by  pathological  conditions.  This  action  of  the  white 
cells  is  known  as  "diapedesis." 

After  leaving  the  blood  stream  in  response  to  some  path- 
ological condition  of  the  tissues,  they  may  either  re-enter  the 
circulation,  be  organized  into  repair  tissue,  or  die  and  become 
pus  cells. 

Some  of  these  cells  have  been  observed  to  surround  and 
dissolve  foreign  substances,  and  are  hence  called  phagocytes. 
Not  all  leucocytes  are  phagocytes,  nor  is  this  function  lim- 
ited to  wandering  cells.  Some  endothelial  cells  also  possess 
this  function.  Metschnikoff  has  stated  a  theory  of  immunity  to 
various  bacterial  diseases  based  on  this  phagocytic  function. 


PEIXCIPLES  OF  OSTEOPATHY.  71 

These  leucocytes  or  their  products  are  concerned  in  the  coag- 
ulation of  the  blood. 

The  origin  of  the  leucocytes  is  supposed  to  be  the  lymph 
glands,  since  more  cells  appear  in  the  fluid  leaving  than  in 
that  entering  the  glands. 

Little  of  a  definite  character  is  known  of  the  blood  plat- 
elets. Fibrin  is  an  albuminous  substance  which  appears 
when  blood  coagulates.  It  is  concerned  in  the  stopping  of 
hemorrhages. 

The  scope  of  this  chapter  does  not  contemplate  a  close 
examination  into  all  the  constitutents  of  the  blood,  but  we 
desire  to  impress  upon  our  readers  the  universality  of  func- 
tion possessed  by  the  blood. 

Chemical  Constituents. — The  chemical  constituents  of 
the  plasma  are  very  numerous,  and  it  would  require  consider- 
able space  to  even  enumerate  them.  There  are  inorganic  and 
organic  substances,  some  of  which  act  as  food  for  the  tissues, 
others  being  the  result  of  katabolism. 

Aside  from  the  chemical  constituents,  there  are  many 
ferments.  Besides  the  well  known  fibrin  ferment,  there  are 
diastatic,  glycolytic,  lipolytic  ferments.  Serum  also  possesses 
a  globucidal  and  bactericidal  action. 

From  this  suggestive  review  of  definite  constituents  of 
the  blood,  it  will  be  readily  noted  that  our  classification  of 
the  functions  of  the  blood  is  not  too  broad. 

Distribution  of  the  Blood. — Granting  that  the  blood 
possesses  all  these  functions,  the  question  still  confronts  us, 
How  can  we  affect  its  distribution?  This  question  leads  us 
to  a  consideration  of  the  physiological  distribution  of  the 
blood.  It  is  believed  by  the  writer  that  nothing  besides  the 
use  of  water  has  so  great  an  effect  on  the  circulation  of  the 
blood  as  manipulation  according  to  osteopathic  methods. 
These  methods  do  not  depend  on  a  mere  physical  assistance 
of  the  venous  flow  by  means  of  centripetal  stroking,  such  as 
is  employed  by  a  masseur.  Effects  on  circulation  are  obtained 
in  nearly  all  cases  by  knowing  where  definite  nerves  which 
control  the  action  of  the  heart  and  blood  vessels  are  placed 
and  what  their  action  in  response  to  irritation  may  be.  All 


72  PRINCIPLES   OF  OSTEOPATHY. 

manipulations  are  given  with  a  definite  knowledge  of  the  lo- 
cation of  blood  vessels  and  the  nerve  centers  which  control 
their  variation  in  calibre.  The  response  secured  is  a  nezv  co- 
ordination of  the  whole  circulation  brought  about  under  the 
control  of  the  nerve  centers.  Compression  of  the  carotids  by 
the  fingers  will  lessen  the  amount  of  blood  flowing  to  the 
brain,  but  such  a  compression  has  no  effect  after  the  fingers 
are  removed.  From  the  osteopathic  standpoint  this  proced- 
ure would  be  considered  useless.  Physiological  experiments 
have  demonstrated  that  the  blood  vessels  of  the  head  and 
brain  will  contract  in  response  to  stimuli  from  definite  areas; 
therefore,  osteopaths  treat  these  areas  and  thus  secure  a  re- 
adjustment of  the  entire  circulation  which  is  more  lasting 
than  can  possibly  be  secured  by  definite  compression. 

It  has  been  stated  that  the  blood  is  contained  in  a  closed 
system  of  tubes.  A  short  resume  of  the  most  important  points 
in  the  anatomy  and  physiology  of  the  circulation  may  pre- 
pare us  for  a  clearer  insight  of  the  modus  operandi  of  os- 
teopathic methods. 

The  Circulatory  Apparatus. — The  circulatory  appa- 
ratus consists  of  the  heart,  arteries,  capillaries,  veins  and  lym- 
phatics; some  writers  include  the  spleen. 

Muscular  tissue  is  found  in  the  heart,  small  arteries  and 
veins.  The  heart  is  practically  all  muscle,  and  its  contrac- 
tions are  governed  by  two  sets  of  nerve  fibers  from  the  cerebro- 
spinal  system,  the  first  set  is  called  accelerator;  second,  in- 
hibitory. 

Likewise,  the  small  arteries  and  veins  have  two  sets  of 
fibres  which  increase  and  decrease  the  intensity  of  the  contrac- 
tion of  their  muscular  fibres,  and  thus  change  the  calibre  of 
the  vessels. 

The  capillaries  are  short,  narrow  tubes,  having  a  thin 
wall  composed  of  nucleated  cells  which  possess  the  power 
of  contraction.  So  far  as  known,  the  capillaries  expand  and 
contract  in  response  to  the  degree  of  physical  pressure  exerted 
by  the  blood  current  coming  from  the  arterioles.  Thus  the 
change  in  the  calibre  of  the  capillaries  is  passive.  The  lym- 
phatics begin  in  small  irregular  spaces  in  the  cellular  tissue  out- 


PKIXCIPLES  OF  OSTEOPATHY.  73 

side  of  the  blood  vessels.  They  are  found  in  direct  relation 
with  the  cells  of  perivascular  tissues,  thus  bringing  the  lymph  to 
each  cell.  These  openings  lead  to  small  lymphatic  vessels  which 
convey  the  lymph  to  the  lymphatic  glands  which  are  situated 
so  as  to  filter  out  the  impurities,  after  which  it  is  emptied 
into  the  venous  circulation  by  the  lymphatic  ducts.  The  lym- 
phatic vessels  possess  power  of  contraction.  The  lymph  equals 
about  one-third  of  the  body  weight. 

The  blood  is  a  passively  moving  tissue.  It  is  kept  in 
constant  circulation  within  a  closed  system  of  tubes  by  a  com- 
bination of  forces.  The  propulsion  of  the  blood  is  almost 
entirely  accomplished  by  the  contraction  of  the  heart.  This 
initial  force  is  supplemented  by  the  aspiration  of  the  chest  dur- 
ing respiration,  and  the  contraction  of  the  skeletal  muscles 
of  the  entire  body.  It  is  a  debatable  question  whether  or  not 
the  muscular  coat  of  the  arterioles  and  venules  assist  in  the 
direct  propulsion  of  the  blood  passing  through  them. 

It  is  the  function  of  the  heart  to  maintain  a  compara- 
tively uniform  tension  of  the  blood  in  the  large  arteries.  The 
arterioles  and  capillaries  are  concerned  in  maintaining  re- 
sistance to  the  passage  of  the  blood.  The  degree  of  resist- 
ance in  the  capillaries,  in  large  measure,  determines  the  amount 
of  nourishment  received  by  the  tissues.  The  relation  between 
capillary  resistance  to  the  passage  of  the  blood  and  the  meta- 
bolism carried  on  in  perivascular  tissues  is  a  point  of  great  im- 
portance. The  current  of  blood  ordinarily  passes  through  the 
capillaries  very  slowly,  at  a  rate  of  one  inch  in  two  minutes, 
and  under  low  tension,  thus  giving  ample  opportunity  for  the 
escape  of  nourishing  material  for  the  surrounding  tissues. 

Tension  in  the  arteries  is  maintained  by  three  factors : 
I.  The  initial  force  of  the  heart  beat;  2.  Friction  in  the 
vessels ;  3.  Elasticity  of  the  vessel  walls.  The  first  and 
third  of  these  factors  are  under  nerve  control  which  act  ac- 
cording to  a  large  number  of  stimuli. 

The  capillaries  being  passive  in  action,  the  tension  of  the 
blood  stream  in  them  is  mainly  dependent  on  the  tension  in 
the  arterioles.  It  may  be  profitably  noted  that  after  the  initial 
impulse  is  given  to  the  blood  stream  by  the  heart,  the  distri- 


74  PRINCIPLES   OF  OSTEOPATHY. 

bution  of  this  blood  depends  solely  on  the  arteries,  arterioles 
and  capillaries.  This  peripheral  distributive  mechanism  is 
therefore  responsible  for  the  nutrition  of  the  tissues,  and  its 
resistance  offered  to  the  passage  of  the  blood,  regulates  the 
amount  of  force  exerted  by  the  heart. 

Manipulatory  treatments,  according  to  the  best  authorities 
writing  on  massage  and  Swedisn  movements,  have  for  their 
object  the  acceleration  of  the  blood  flow  on  the  venous  side 
of  the  general  circulation.  Osteopathic  manipulations  are  es- 
sentially directed  to  the  active  instead  of  the  passive  side  of 
the  circulation. 

The  osteopath  makes  use  daily  of  the  vaso-motor  nerves 
in  order  to  control  the  circulation  of  the  blood  in  local  areas ; 
therefore,  it  is  necessary  to  make  a  detailed  study  of  this  won- 
derful mechanism  in  order  to  achieve  the  best  results  in  prac- 
tice. 

The  more  we  know  of  structure  and  function,  the  more 
rational  ought  our  methods  of  treatment  to  be,  because  we 
will  then  have  no  excuse  for  using  methods  which  do  not 
have  a  scientific  basis  to  recommend  them. 

The  Heart. — In  order  to  affect  the  active  side  of  the 
circulation  our  manipulations  must  affect  the  heart  beat. 
There  are  two  sets  of  nerve  fibres  arising  in  the  cerebro-spinal 
system  which  exert  a  regulating  influence  on  the  beat  of  the 
heart.  Heart  muscle  possesses  an  inherent  power  of  rhyth- 
mical contraction  as  can  be  readily  proven  by  removing  the 
heart  from  the  body  and  stimulating  it  mechanically.  It  will 
beat  rhythmically  for  hours  if  the  muscle  be  kept  moist  with 
a  one  per  cent  salt  solution. 

Contraction  begins  in  the  auricles  and  ends  in  the  ven- 
tricles ;  hence,  it  is  thought  that  the  auricular  rhythm  is  trans- 
mitted to  the  ventricle.  Any  influence  which  changes  the 
auricular  rhythm  also  changes  the  ventricular  rhythm. 

Regulation  of  Contraction. — Since  the  heart  possesses 
inherent  power  of  rhythmic  contraction,  the  nervous  system 
acts  merely  as  a  regulator  of  the  rate  of  contraction.  The 
two  centers  of  cardiac  control  act  in  a  manner  to  increase  or 
decrease  the  rate.  The  speed  of  the  blood  current  is  depend- 


PRINCIPLES   OF  OSTEOPATHY.  75 

ent  on  the  rate  and  strength  of  the  cardiac  contractions.  The 
pressure  of  the  blood  is  dependent  on  the  rate  and  strength 
of  the  cardiac  contractions,  together  with  the  resistance  offered 
by  the  arterioles  and  capillaries.  Considering  the  arterioles 
and  capillaries  as  possessing  fixed  diameters,  an  increase  in 
the  number  and  strength  of  the  heart  beats  would  increase 
the  speed  and  pressure  of  the  blood  current.  A  lessened  car- 
diac activity  would  have  the  opposite  effect.  The  speed  and 
pressure  of  the  blood  stream  may  vary  within  wide  limits  and 
still  maintain  a  fair  degree  of  health. 

Co-ordinating  Centers. — The  nerve  impulses  reaching 
the  heart  are  co-ordinated  in  two  governing  centers  in  the 
cerebro-spinal  system.  These  centers  are  located  in  the  bulb. 
The  inhibitory  center  is  connected  with  cells  in  the  walls  of 
the  heart  by  fibres  which  form  a  part  of  the  pneumogastric 
nerve.  Section  of  the  pneumogastric  nerve  removes  the  in- 
hibitory influence  over  the  heart's  action.  Stimulation  of  this 
nerve  slows  the  heart.  The  relaxation  period  is  lengthened 
which  results  in  greater  filling  of  the  heart  and  the  pressure 
in  the  veins  is  increased  while  arterial  pressure  decreases. 
These  results  have  been  noted  by  many  physiologists. 

The  Pneumogastric  Nerve. — The  pneumogastric  is  one 
of  the  nerve  trunks  which  can  be  reached  by  direct  pressure 
made  through  the  skin  and  muscles  of  the  neck.  Its  inhibi- 
tory action  can  be  aroused  by  pinching  the  sterno-cleido- 
mastoid  muscle  between  the  thumb  and  forefinger,  taking  care 
to  work  deeply  under  the  internal  margin  of  the  muscle. 

It  is  no  uncommon  phenomenon  to  have  a  patient  faint 
as  a  result  of  this  manipulation.  Individuals  differ  greatly 
as  to  their  response  to  this  stimulation.  The  stimulation 
should  be  a  gentle  pressure  of  a  constantly  varying  intensity. 

A  pulse  tracing  is  appended,  Fig.  19,  which  shows  the 
results  of  stimulating  the  pneumogastric  in  the  manner  just 
described.  The  gentleman  upon  whom  the  experiment  was 
made  was  in  excellent  health,  and  possessed  a  quiet,  well- 
balanced  temperament.  The  tracing  shows  that  the  number 
and  force  of  the  beats  was  lessened  and  arterial  pressure  de- 
creased. This  tracing  is  probably  typical  of  the  change,  in  a 


76  PRINCIPLES  OF  OSTEOPATHY. 

well  person,  in  response  to  stimulation  of  the  pneumogastric. 
No  sensation  of  faintness  or  other  disagreeable  feeling  was 
noted. 

The  inhibitory  action  of  the  pneumogastric  seems  to 
be  most  active  in  individuals  who  suffer  from  some  disorder 
of  the  digestive  tract.  In  such  patients  the  constant  irrita- 
tion of  the  sensory  fibres  of  the  pneumogastric,  which  arise 
in  the  mucosa  of  the  digestive  viscera,  seems  to  increase  the 
irritability  of  the  whole  nerve  trunk  to  such  a  delicate  point 
that  the  slightest  stimulation  made  at  any  point  along  the 


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Fig.  19. — Stimulation  of  the  pneumogastric  by  pinching  the  nerve  trunk  in  the  neck. 

course  of  the  nerve  will  excite  its  inhibitory  action.  Many 
osteopaths,  just  starting  in  practice,  have  had  their  self-pos- 
session severely  tried  by  a  patient  fainting  during  manipula- 
tion of  the  neck.  I  have  never  heard  of  any  fatal  results 
from  manipulation  of  the  pneumogastric.  Why  stimulation 
of  the  pneumogastric  should  result  in  cardiac  inhibition  rather 
than  in  phenomena  connected  with  its  other  branches  seems 
incapable  of  explanation.  Sometimes  spasm  of  the  laryngeal 
muscles  will  accompany  cardiac  inhibition. 

The  intensity  of  action  of  the  pneumogastrics  is  so  well 
known  to  experienced  osteopaths  that  they  are  careful  to  test 


PEIXCIPLES  OF   OSTEOPATHY.  77 

its  irritableness  in  cases  before  undertaking  any  extensive 
manipulations  along  its  course. 

The  inhibitory  center  is  continually  active,  and  acts  ac- 
cording to  the  blood  pressure  within  the  arteries.  A  rise  in 
peripheral  resistance  causes  a  decrease  in  number  and  strength 
of  the  heart  beats. 

Accelerator  Center. — The  accelerator  center  is  con- 
nected with  the  heart  by  fibres  which  descend  in  the  cord  to 
the  upper  portion  of  the  dorsal  region;  here  connection  is 
made  with  the  cells  whose  fibres  pass  to  the  sympathetic  spinal 
ganglia,  ist,  2nd,  and  3rd  dorsal,  and  end  there  around  other 
cells  whose  fibres  convey  their  impulses  to  the  heart. 

The  action  of  the  accelerator  center  is  not  so  readily 
demonstrated  as  is  the  case  with  the  inhibitory  center.  It 
causes  the  heart  to  beat  faster  and  stronger,  thus  bringing 
about  a  rise  in  arterial  blood  pressure  and  a  fall  in  venous 
pressure.  This  center  acts  in  response  to  lowered  peripheral 
resistance.  The  products  of  metabolism  brought  about  by 
physical  exercise  also  excite  it.  Deep,  steady  pressure  made 
on  the  muscles  lying  on  each  side  of  the  ist,  2nd  and  3rd  dorsal 
spines  causes  a  decrease  in  the  rapidity  of  the  heart's  action. 


Fig.   20. — Sphygmograms   illustrating  the  effect  of   inhibition   at  the    ist,   and  and 

3rd  doraal. 


Stimulation  of  the  Heart. — A  make  and  break  pressure 
made  at  the  edge  of  the  sternum  in  the  ist  and  2nd  inter- 
costal spaces  will  usually  stimulate  the  heart.  Sometimes  the 
first  effect  is  inhibition,  but  it  quickly  passes  to  stimulation. 
The  manipulation  made  anteriorly  increases  the  number  and 
intensity  of  the  stimuli  reaching  the  segment  of  the  cord  from 


78  PKINCIPLES  OF   OSTEOPATHY. 

which  the  accelerator  nerves  pass  out.  All  centers  act  accord- 
ing to  the  sum  of  the  stimuli  reaching  them  from  all  sources. 

Inhibition  of  the  Heart. — In  cases  of  rapid  heart  beat 
with  high  tension  pulse  the  best  effects  are  secured  by  digi- 
tal pressure  at  ist,  2nd  and  3rd  dorsal  spines.  The  pneu- 
mogastrics  have  too  many  branches  to  important  viscera  and 
act  frequently  with  unexpected  intensity.  The  accelerators 
act  more  slowly  with  less  intensity  and  the  action  is  sus- 
tained longer,  that  is,  as  a  result  of  manipulation. 

Vaso-motor  Control  of  the  Coronary  Arteries. — A  fur- 
ther factor  in  relation  to  the  regulation  of  the  heart's  action 
is  the  blood  supply  for  the  nourishment  of  the  heart.  All 
organs  act  with  greater  force  when  their  blood  supply  is 
abundant.  The  heart  beats  stronger  when  its  coronary  arteries 
are  dilated  than  when  constricted,  therefore  the  power  of  the 
heart  depends  on  the  vaso-motor  control  of  its  own  arteries. 
The  vaso-motor  nerves  to  the  coronary  arteries  leave  the 
cerebro-spinal  system  between  the  3rd  and  5th  dorsal  spines. 
In  cases  of  angina  pectoris,  this  area  will  be  sensitive.  Steady 
pressure  here  will  dilate  the  coronary  arteries  and  ease  the 
pain.  A  sharp  stroke  with  the  hypothenar  eminence  on  the 
fourth  dorsal  spine  will  nearly  always  start  an  attack  with 
such  patients. 

Angina  Pectoris. — Physiologists  name  the  pneumogas- 
tric  nerve  as  the  vaso-motor  nerve  to  the  coronary  arteries. 
I  mention  the  area,  3rd  to  5th  dorsal,  as  a  vaso-motor  center 
for  the  coronary  arteries  because  clinical  experience  seems 
to  demonstrate  it.  Other  osteopaths  have  noted  the  frequency 
of  lesions  in  this  area  in  connection  with  heart  difficulties.  The 
lesions  are  contracted  muscles,  lateral  subluxations  of  the  ver- 
tebrae or  in  some  instances  subluxations  of  the  fourth  and 
fifth  ribs.  With  any  of  these  lesions  there  is  intense  sensi- 
tiveness. 

Dr.  George  Keith,  of  Scotland,  mentions  digital  pressure 
in  the  second  left  intercostal  space  as  a  means  of  inhibiting 
an  attack  of  angina  pectoris,  and  suggests  the  nerve  connec- 
tion of  the  pneumogastric  as  being  the  nerve  path  over  which 
the  inhibitory  impulse  travels. 


PEIXCIPLES   OF  OSTEOPATHY.  79 

Persons  suffering  with  angina  pectoris  will  press  their 
hands,  with  all  the  force  they  possess,  against  the  left  chest. 
I  have  used  heavy  digital  pressure  on  the  left  side  of  the 
fourth  and  fifth  dorsal  spines  while  the  patient  was  in  a 
paroxysm  of  pain.  The  pressure  never  failed  to  be  grateful 
to  the  patient.  A  further  experiment  with  this  center  was 
made  by  extending  the  patient  in  a  recumbent  position.  While 
extension  was  maintained  the  angles  of  the  ribs  could  be 
raised,  the  left  arm  could  be  extended  over  the  head,  a  full 
inspiration  could  be  taken,  but  as  soon  as  the  vertebrae  were 
allowed  to  approximate  as  a  result  of  cessation  of  extension, 
these  things  could  not  be  done. 

Heat,  digital  pressure,  and  counter  irritation  are  capable 
of  causing  vaso-constrictor  paralysis,  i.  e.,  vaso  dilation,  and 
hence  increase  the  power  of  the  heart  in  such  cases. 

Action  of  the  Heart  Centers. — The  governing  centers 
of  the  heart  act  principally  according  to  the  peripheral  resist- 
ance maintained  by  the  blood  vessels.  The  heart  possesses 
a  nerve  called  the  depressor  nerve.  Its  endings  are  in  the 
walls  of  the  heart  and  are  affected  by  the  pressure  of  the  blood 
within  the  heart.  A  rise  in  arterial  pressure  is  followed  by  a 
rise  in  pressure  within  the  heart.  The  depressor  nerve  notes, 
this  fact  and  carries  an  inhibitory  impulse  to  the  vaso-dilator 
center  in  the  medulla,  thus  bringing  about  a  fall  in  arterial 
pressure.  In  this  way  the  heart  is  protected  from  over  exer- 
tion as  a  result  of  too  high  pressure. 

In  cases  having  rapid,  weak  heart  action,  inhibit  the  ac- 
celerators to  slow  the'  heart,  also  inhibit  in  the  area  of  vaso- 
motor  control  of  the  coronary  arteries  to  increase  the  amount 
of  blood  for  nourishment  to  the  heart  muscle,  thus  increasing 
the  strength  of  the  beat. 

In  cases  of  rapid,  high  tension  pulse,  inhibit  the  splanch- 
nics  and  suboccipital  fossae  to  lessen  peripheral  resistance,  also 
inhibit  the  accelerators  or  stimulate  the  pneumogastrics. 

Vaso-motor  Nerves. — In  1840  Henle  discovered  and 
demonstrated  the  muscular  coat  of  the  arteries,  and  as  a  result 
of  this  step  forward  we  have  our  present  knowledge  of  the 
vaso-motor  nerves.  Associated  with  the  demonstration  of 


8o 


PEINCIPLES  OF  OSTEOPATHY. 


these  nerves,  we  have  the  names  of  Brown-Sequard,  Bernard, 
Waller  and  Schiff. 

It  has  been  proven  that  two  sets  of  fibres  innervate  the 
muscles  of  the  arteries;  a  vaso-constrictor  set,  which  causes  a 
decrease  in  the  calibre ;  and  a  vaso-dilator  set  which  causes 
an  increase  in  calibre.  The  constrictors  were  demonstrated 
first. 


Fig.  2i.— Drawn  by  J.   E.   Stuart,  D.   O. 

Henle  said  "the  movement  of  the  blood  depends  on  the 
heart,  but  its  distribution  depends  on  the  vessels."  We  have 
followed  the  phenomena  in  connection  with  the  first  part  of 
this  quotation,  hence  it  remains  for  us  to  study  the  part 
played  by  the  vessels  in  the  distribution  of  the  blood. 

In  order  to  carry  our  thoughts  along  in  a  proper  man- 
ner, we  will  commence  at  the  center  and  work  toward  the 
periphery. 

The  chief  vaso-motor  center  is  in  the  medulla.  Destruc- 
tion of  this  center  causes  an  immediate  fall  of  blood  pressure 
all  over  the  body.  Stimulation  of  this  center  causes  a  general 
rise  of  blood  pressure. 

There  are  subsidiary  centers  situated  at  various  levels  in 
the  spinal  cord. 

After  the  spinal  cord  is  severed,  that  portion  which  is  no 
longer  connected  with  the  chief  vaso-motor  center  will  exer- 
cise a  vaso-constrictor  influence  over  the  blood  vessels  in  its 
area  of  normal  control.  "It  is  probable  that  they  are  nor- 
mally subordinate  to  the  bulbar  nerve  cells." 


PKINCIPLES   OF  OSTEOPATHY.  8l 

After  all  connection  between  the  cerebro-spinal  system 
and  sympathetic  spinal  ganglia  is  cut  off,  the  tone  of  the  blood 
vessels  is  maintained,  after  a  short  interval,  by  the  sympathetic 
ganglia. 

By  commencing  at  the  center  and  destroying  it,  then  the 
centers  in  the  spinal  cord  assume  control ;  destruction  of  these 
leaves  the  sympathetic  spinal  ganglia  active;  hence  by  this 
process  of  exclusion,  we  find  that  the  true  vasq-motor  cells  are 
sympathetic  and  lie  in  the  spinal  ganglia.  From  these  cells  in 
the  spinal  ganglia  axis  cylinder  processes  pass  as  gray  fibres  to 
blood  vessels.  These  ganglia  cells  are  controlled  by  fibres  from 
the  chief  vaso-motor  center  in  the  medulla  which  end  around 
the  subsidiary  cells  in  the  spinal  cord,  the  neuraxons  of  these 
latter  terminating  by  filaments  which  surround  the  true  vaso- 
motor  cells  in  the  sympathetic  spinal  ganglia. 

Since  gray  rami-communicantes  pass  from  the  spinal  sym- 
pathetic ganglia  to  the  spinal  nerves  and  are  distributed  with 
them  to  the  skin  and  blood  vessels,  we  can  influence  the  dis- 
tribution of  the  blood  generally  and  locally  by  increasing  or 
decreasing  the  number  of  sensory  impulses^  originating  in 
the  skin  and  muscle,  which  may  reach  the  vaso-motor  centers. 

"The  vaso-motor  apparatus  consists,  then,  of  three  classes 
of  nerve  cells.  The  cell  bodies  of  the  first  class  lie  in  sympa- 
thetic ganglia,  their  neuraxons  passing  directly  to  the  smooth 
muscle  in  the  walls  of  the  vessels;  the  second  are  stimulated 
at  different  levels  in  the  cerebro-spinal  axis,  their  neuraxons 
passing  hence  to  the  sympathetic  ganglia  by  way  of  spinal  and 
cranial  nerves ;  and  the  third  are  placed  in  the  bulb  and  control 
the  second  through  intraspinal  and  intracranial  paths.  The 
nerve  cell  of  the  first  class  lies  wholly  without  the  cerebro- 
spinal  axis,  the  third  wholly  within  it,  while  the  second  is 
partly  within  and  partly  without,  and  binds  together  the  re- 
maining two."  Am.  Text-book  of  Physiology. 

Vaso-constriction. — The  vaso-constrictor  nerves  which 
pass  from  the  bulbar  and  spinal  centers  of  control  leave  the 
cord  as  white  rami-communicantes  from  the  anterior  roots  of 
the  second  dorsal  to  the  second  lumbar  nerves  and  enter  the 
sympathetic  ganglia  to  be  distributed  as  has  been  described 


82 


PRINCIPLES   OF  OSTEOPATHY. 


Fig.   22. — Yaso-constrictor  area,   2nd   Dorsal  to   2nd  Lumbar. 

before.  It  is  believed  that  all  of  these  vaso-constrictor  fibres 
end  in  the  ganglia,  thus  exerting  their  influence  on  the  true 
vaso-motor  cells  in  the  ganglia  which,  alone  send  fibres  to 
the  blood  vessels.  All  these  constrictor  nerves  are  gray. 


PBINCIPLES   OF   OSTEOPATHY. 


Fig.  23. — Arterial  tension  is  manifested  in  a  sphygmogram  by  the  relative  height 
of  the  aortic  notch.  The  upper  tracing  shows  the  aortic  notch  on  a  straight 
line  drawn  from  the  top  of  one  percussion  wave  to  the  bottom  of  the  next. 
The  middle  tracing  shows  this  notch  very  low. 

Vaso-dilation. — The  vasodilator  ^fibers  are  riot  re- 
stricted to  any  one  portion  of  the  cord  or  brain,  but  pass  out 
with  both  cranial  and  spinal  nerves,  and  do  not  lose  their 
sheaths  until  they  reach  their  destination.  They  are  best  dem- 
onstrated in  those  regions  of  the  cerebro-spinal  system  from 
which  vaso-constrictors  do  not  arise.  The  vaso-dilators  from 
the  head,  face,  salivary  glands,  etc.,  pass  to  their  destination 
with  the  cranial  nerves  supplying  these  parts.  They  do  not 
end  in  the  sympathetics.  They  probably  leave  the  cord  in  the 
anterior  roots  of  the  spinal  nerves  and  pass  to  the  periphery 
without  interruption.  The  vaso-dilators,  leaving  the  cord  in 
the  same  region  as  the  vaso-constrictors  to  be  distributed  to 
the  visceral  blood  vessels  probably  pass  out  by  the  ventral  roots 
and  reach  their  destination  without  losing  their  sheaths  in  the 
sympathetic  ganglia. 


Fig.  24. — The  significance  of  a  sphygmogram.  The  space  S  is  the  period  of  ven- 
tricular systole  when  the  aortic  valves  are  open;  the  space  D  the  period  of 
ventricular  diastole;  t  the  tidal  wave  due  to  the  ventricular  systole;  p  the 
percussion  wave  due  to  instrumental  defect;  p  is  the  aortJc  notch  which  marks 
the  closure  of  the  aortic  valves;  d  the  dicrotic  wave. 

No  distinct  centers  for  vaso-dilator  fibres  have  been  dem- 
onstrated. They  probably  arise  from  segments  of  the  brain 
and  spinal  cord  and  their  influence  is  carried  along  the  paths 
of  motor  nerves  and  is  exerted  in  a  local  area. 


84  PBINCIPLES  OF  OSTEOPATHY. 

Summary. — i.  The  vaso-dilator  nerves  are  cerebro- 
spinal;  (a)  and  are  not  demedullated  in  the  sympathetic 
ganglia,  (b)  They  are  distributed  principally  to  the  arteries  of 
the  muscles;  (c)  and  leave  the  cerebro-spinal  axis  with  the 
motor  nerves  from  all  portions,  (d)  Their  influence  is  local. 

2.  The  vaso-constrictors  are  essentially  neuraxons  of 
sympathetic  cells  in  the  spinal  ganglia;  (a)  are  gray  fibers; 
(b)  are  distributed  to  viscera  and  cutaneous  blood  vessels ; 


Fig.  25. — Sphygmograms  illustrating  Tachycardia  and  Bradycardia.  Upper  tracing 
is  from  radial  pulse  of  a  woman  exhibiting  great  nervousness,  a  small  goitre 
but  no  exophthlalmos.  Lower  tracing  is  from  radial  pulse  of  a  young  man 
whose  power  of  recalling  past  events  of  his  own  life  was  suddenly  lost.  Result 
of  mental  shock. 

(c)  and  are  probably  continuous  in  action  to  maintain  the 
tone  of  the  vascular  system,  (d)  The  vaso-motor  cells  in  the 
sympathetic  ganglia  can  act  independently,  (e)  but  are  nor- 
mally under  the  control  of  the  cells  in  the  spinal  cord  whose 
neuraxons  end  in  the  spinal  ganglia,  (f)  These  cells  in  the 
spinal  cord  are  under  the  influence  of  neuraxons  of  cells  in  the 
medulla  which  constitute  the  chief  vaso-motor  center,  (g) 
Therefore,  the  vaso-constrictor  influence  is  both  local  and 
general,  (h)  The  controlling  fibres  leave  the  cord  in  the 
ventral  roots  of  the  second  dorsal  to  the  second  lumbar  nerves 
only. 

THE  SENSORY  NERVES. 

We  have  now  considered  in  detail  only  one  side  of  the 
vaso-motor  mechanism,  the  motor.  We  have  yet  to  note  the 
sensory  side,  that  which  calls  forth  the  motor  response.  If 
there  were  no  chief  or  spinal  vaso-motor  centers  to  transfer 
sensory  impulses  to  the  vaso-constrictor  cells  in  the  spinal 
ganglia,  the  blood  vessels  in  the  viscera  and  skin,  could  not 


PRINCIPLES   OF  OSTEOPATHY.  85 

contract  or  relax  according  to  the  necessity  for  greater  or  less 
amounts  of  heat  in  the  deep  or  superficial  areas. 

The  vaso-motor  centers  in  the  brain  and  cord  send  out 
impulses  in  response  to  sensory  stimulation;  this  sensory  stim- 
ulation is  usually  of  a  thermal  or  mechanical  character. 

It  is  difficult  to  realize  the  extent  of  the  distribution  of 
sensory  nerves.  "They  are  located  not  only  in  those  places 
usually  known  to  be  sensitive,  but  also  in  all  other  tissues  and 
organs.  Whether  one  examine  the  liver  or  the  kidney,  lung 
or  the  wall  of  a  blood  vessel,  one  always  finds  delicate  nerve 
arborizations  in  unsuspected  numbers.  A  large  portion  of 
them  end  probably  in  the  peripherally  placed  end  cells  belong- 
ing to  the  reflex  arc  of  the  sympathetic;  another  portion  may 
very  probably  be  traced  to  the  spinal  ganglia,  and  even  to 
the  spinal  cord  itself,  especially  the  investigations  of  the  past 
two  years,  making  use  of  the  silver  and  methyl  blue  stains,  have 
not  only  disclosed  the  wealth  of  nerves  in  the  different  or- 
gans, but  have  also  shown  that  we  have  regarded  the  sensory 
innervation  of  the  sensitive  surfaces,  as  the  skin,  and  the 
gustatory-mucous  membrane  as  much  less  fully  explained  than 
they  really  are.  One  finds  there  numerous  plexuses  of  nerve 
fibres  beneath  and  between  the  epithelial  cells,  and  they  send 
one,  often  many  fine  fibrils  to  each  cell."  *  *  *  *  "In  the 
liver,  too,  and  the  bladder,  and  many  other  places,  one  can 
find  numerous  examples  of  the  abundant  peripheral  innerva- 
tion. We  have  always  given  too  great  importance  to  the 
single  end  apparatus,  overlooking  the  fact  that  really  the  major 
portion  of  the  body  tissues  is  supplied  with  nerves  for  every 
cell.  One  can  hardly  overestimate  the  wealth  of  nerve  fibres  in 
the  end  organs  themselves,  as  the  taste  papillae  and  the  tactile 
papillae.  Good  staining  discloses  with  each  of  them  plexuses 
of  unexpected  density  of  arborization." 

"For  what  services  may  such  an  abundant  sensory  inner- 
vation be  provided?  It  occurs  immediately  to  one  that  there 
is  a  great  number  of  reflexes,  very  necessary  to  the  preserva- 
tion of  the  individual,  even  though  he  be  unaware  of  them. 
The  regulation  of  the  secretions,  the  blood  supply  to  the  skin 
in  relation  to  the  caloric  body  economy  of  the  organism,  the 


86  PEINCIPLES  OF  OSTEOPATHY. 

adjustment  to  varying  illumination,  the  tension  of  the  muscles 
and  tendons  through  the  respective  tendon  reflexes,  the  dif- 
ferent response  by  such  varying  tensions  according  to  the  in- 
tensity of  the  voluntary  impulse,  and  many  other  phenomena 
could  be  cited.  To  all  of  them  is  necessary,  besides  the  motor 
part  of  the  reflex  arc,  a  sensory  part.  Indeed,  Exner,  to  whom 
we  are  indebted  for  indicating  the  importance  of  these  short 
reflex  arcs  and  the  roles  they  play  in  the  organism,  has  pointed 
out  how,  in  general,  for  the  production  of  any  movement  the 
sensory  innervation  must  be  intact." 

"By  'sensory  innervation,'  however,  one  must  not  think 
only  those  processes  are  meant  which  enter  into  our  conscious- 
ness, but  rather  all  those  by  which  from  any  place  in  the  body 
impressions  are  conducted  to  the  nearest  ganglion,  or  to  the 
central  axis.  Whether  they  be  conducted  farther  still,  or 
whether  they  be  recognized  by  the  individual  as  they  occur  does 
not  affect  their  nature.  Sensation  and  perception  are  not  the 
same  thing." — Anatomy  of  the  Central  Nervous  System  in 
Man  and  in  Vertebrates  in  General. — Edinger. 

Thus  we  find  that  there  are  abundant  sensory  nerves  in 
superficial  and  deep  tissue  to  receive  the  mechanical  stimuli 
which  the  osteopath  may  project  upon  them. 

Recent  investigations  prove  that  many  conditions  which 
have  previously  been  called  inflammation  are,  in  reality,  con- 
gestions due  to  vaso-constrictor  paralysis,  and  can  be  cor- 
rected by  stimulation  of  the  vaso-constrictor  center  govern- 
ing the  congested  area ;  the  stimulation  of  such  center  being 
secured  by  mechanical  stimuli  applied  to  the  sensory  nerves 
ending  in  the  center. 

The  vaso-motor  mechanism  responds  quickly  to  osteo- 
pathic  manipulation,  and  is  our  means  of  correcting  any 
disturbance  of  circulation  both  local  and  general. 

Since  the  blood  carries  the  nourishment  for  the  tissues, 
and  the  vaso-motors  control  the  distribution  of  the  blood,  the 
vaso-motor  nerves  are  trophic  nerves.  In  the  same  sense  they 
are  secretory  nerves. 

Capillary  Circulation. — The  capillary  circulation  is 
dependent  on  the  state  of  the  arterioles.  Their  walls  are 


PBINCIPLES  OF  OSTEOPATHY.  87 

formed  by  endothelial  cells  which  are  elastic,  and  hence  re- 
spond to  the  force  of  the  blood  which  enters  them.  If  the 
vaso-constrictors  are  active  in  a  local  area  the  resistance 
offered  to  the  passage  of  the  blood  current  by  the  arterioles 
is  increased,  and  therefore  the  pressure  exerted  on  the  capillary 
walls  is  lessened,  allowing  the  capillaries  to  contract.  If  the 
vaso-constrictor  influence  over  the  arterioles  be  lessened,  the 
blood  current  is  allowed  to  exert  its  pressure  on  the  capillary 
walls,  thus  increasing  the  calibre  of  the  capillary. 

If,  in  a  large  area  of  the  body,  vaso-constrictors  are 
active,  the  influence  of  this  resistance  is  felt  by  the  heart, 
which  immediately  beats  harder  to  overcome  the  resistance  to 
the  passage  of  the  blood  through  the  constricted  arteries.  The 
heart  is  usually  relieved  by  compensatory  dilatation  of  the 
arteries  in  some  other  area.  The  visceral  and  cutaneous 
arteries  usually  counter-balance  each  other  in  this  way.  This 
counter-balancing  effect  is  probably  brought  about  through  the 
sensory  impressions  sent  out  from  an  overworked  heart  to  the 
vaso-motor  center,  thus  causing  a  lessened  constrictor  effect  in 
some  portion  of  the  body. 

The  relaxation  of  all  the  arteries  of  the  body  would  cause 
death,  because  the  blood  would  gravitate  to  the  most  de- 
pendent part,  and  there  is  not  blood  enough  to  fill  all  the 
arteries  when  relaxed.  A  slight  relaxation  of  general  blood 
pressure  causes  the  heart  to  beat  more  rapidly  for  a  short 
time.  Relaxation  of  the  peripheral  blood  vessels  is  noted  by 
the  increased  warmth  and  redness  of  the  area  in  which  relaxa- 
tion takes  place. 

Recapitulation. — To  recapitulate:  (i)  Capillary  circu- 
lation is  passive.  (2)  Vaso-  constriction  of  the  arterioles 
causes  a  decrease  in  the  lumen  of  the  capillary.  (3)  Vaso-di- 
lation  of  the  arterioles  causes  increase  in  the  lumen  of  the 
capillary.  (4)  General  vaso-constriction  of  the  cutaneous 
blood  vessels  slows  the  heart  and  causes  it  to  work  against 
higher  pressure,  but  the  heart  is  relieved  by  relaxation  of  blood 
vessels  in  visceral  areas,  chiefly  the  splanchnics.  (5)  De- 
crease of  constrictor  effect  on  superficial  vessels  causes  a  more 
rapid  heart  beat,  which  is  quickly  controlled  by  constriction 


88  PEINCIPLES  OF  OSTEOPATHY. 

in  the  splanchnic  area.  (6)  The  vaso-motor  center  in  the 
medulla  acts  according  to  the  sum  of  the  sensory  influences 
reaching  it  from  all  parts  of  the  body.  (7)  The  spinal  vaso- 
motor  centers  act  according  to  the  influences  sent  to  them  by 
the  chief  center  and  the  sensory  impulses  which  enter  their 
segment  of  the  cord. 

Vaso-motor  Centers. — The  vaso-motor  centers  for  the 
various  viscera,  organs  and  members  are  as  follows : 

HEAD  :     The  superior  cervical  ganglion. 

EYE :  The  superior  cervical  ganglion  through  the  fifth 
nerve. 

NOSE,  THROAT,  TONSILS,  TONGUE  and  GUMS : 
By  the  same  path.  Dilator  fibres  for  the  tongue  per  the  lin- 
gual branch  of  the  fifth  cranial  nerve. 

BRAIN :  "Sherrington  and  others  have  demonstrated 
the  presence  of  vaso-motor  nerves  in  the  vessels  of  the  brain. 
It  is  probable  that  the  cerebral  circulation  is  wholly  de- 
pendent upon  the  general  blood  pressure,  and,  inasmuch  as 
the  general  blood  pressure  is  very  markedly  regulated  by 
the  capacious  splanchnic  area,  it  is  obvious  that  the  cerebral 
circulation  may  be  better  controlled  by  modifying  the  blood 
supply  of  the  splanchnic  area  than  by  any  attempts  at  the  modi- 
fication of  the  cerebral  circulation  itself." 

Sympathetic  fibres  to  the  anterior  and  middle  fossae 
come  from  the  superior  cervical  ganglion  per  the  carotid 
plexus.  Sympathetic  fibres  are  distributed  to  the  vessels  in 
the  posterior  fossa  from  the  vertebral  plexus  which  is  formed 
by  fibres  from  the  inferior  cervical  ganglion. 

THYROID  GLAND:  Middle  and  inferior  cervical 
ganglion. 

The  vaso-constrictors  for  the  blood  vessels  of  the  head, 
face  and  neck  with  their  contained  organs  leave  the  spinal 
cord  in  the  upper  dorsal,  second  to  fifth,  and  pass  thence 
through  the  cervical  ganglion. 

LUNGS  :    Second  to  the  sixth  dorsal. 

INTESTINES:  The  vaso-constrictors  for  the  mesen- 
teric  blood  vessels  are  found  in  the  splanchnic  nerves.  Com- 
mencing at  the  fifth  dorsal,  there  is  a  segmental  distribution 


PEIXCIPLES   OF  OSTEOPATHY.  89 

to  the  various  portions  of  the  intestines.  The  lowest  constrictor 
influence  comes  from  the  second  lumbar.  Vaso-dilator  fibres 
are  also  found  in  the  splanchnics. 

LIVER :     Sixth  to  tenth  dorsal,  right  side. 

KIDNEY:     Tenth  to  twelfth  dorsal. 

SPLEEN:  Ninth,  tenth  and  eleventh  dorsal,  left  side. 
The  vagus  is  a  motor  nerve  to  the  muscular  fibres  in  the 
trabeculae  of  the  spleen. 

PORTAL  SYSTEM  :     Fifth  to  ninth  dorsal. 

EXTERNAL  GENERATIVE  ORGANS:  First  and 
second  lumbar,  through  the  lumbar  sympathetic  ganglia,  sec- 
ond to  the  fifth,  to  the  hypogastric  plexus,  thence  through 
the  pelvic  plexuses  and  pudic  nerves  to  the  generative  organs. 
Function,  vaso-constriction.  First,  second  and  third  sacral 
nerves  are  vaso-dilators  to  the  same  organs. 

INTERNAL  GENERATIVE  ORGANS:  Vaso-con- 
strictor  influence  at  first  and  second  lumbar. 

ARTERIES  TO  THE  SKIN  OF  THE  BACK:  Vaso- 
constrictor influence  from  sympathetic  ganglion  of  the  corre- 
sponding segment. 

UPPER  EXTREMITY:  Vaso-constrictor  influence  to 
the  skin,  from  second  to  the  seventh  dorsal. 

LOWER  EXTREMITY:  Sixth  dorsal  to  second  lum- 
bar. 

MUSCLES :  Dilator  influence  to  the  arteries  of  the 
muscles  per  motor  nerves  to  the  muscles. 

Conclusions. — Vaso-motor  nerves  are  of  two  classes, 
viz :  Vaso-constrictor  and  vaso-dilator.  These  nerves  act 
according  to  the  sum  of  the  stimuli  reaching  their  governing 
center  over  sensory  nerves  of  skin,  muscle  and  gland.  There- 
fore the  osteopath  depends  on  increasing  or  decreasing  the 
stimuli  reaching  the  spinal  centers. 

The  heart  is  innervated  by  two  sets  of  nerves  which  con- 
trol it.  These  nerves  arise  from  centers  in  the  cerebro-spinal 
system  and  govern  the  action  of  the  heart  according  to  the 
sum  of  the  stimuli  reaching  their  centers  over  sensory  nerves 
of  skin,  muscle  and  gland,  and  in  harmony  with  the  resistance 
maintained  by  the  peripheral  blood  vessels. 


90  PRINCIPLES  OF  OSTEOPATHY. 

Since  perivascular  tissues  are  dependent  on  the  trans- 
fusion of  nutriment  from  the  blood,  through  the  walls  of  the 
capillaries  into  the  lymph,  and  this  process  of  transfusion  is 
dependent  on  the  tension  and  speed  of  the  current  of  blood 
in  the  capillaries,  any  condition  which  markedly  increases  or 
decreases  this  speed  and  tension  will  affect  the  nourishment 
of  the  tissues. 

Pathology. — Our  pathology  is  largely  a  study  of  hy- 
peraemic  and  ischaemic  conditions.  Our  methods  of  diagnosis 
ferret  out  these  conditions  quickly,  and  our  therapeutics  are 
planned  to  control  them  by  purely  scientific  methods,  i.  e., 
by  means  of  the  nerves  governing  heart  action  and  arterial 
tension.  Where  passive  circulatory  disturbances  exist,  atten- 
tion is  paid  to  the  venous  side  of  the  circulatory  apparatus. 

Hyperaemia  is  probably  the  most  prevalent  disturbance 
of  the  circulation  with  which  we  come  in  contact.  Such  a 
condition  as  this  is  a  predisposing  factor  in  the  establish- 
ment of  bacterial  inflammation.  The  hyperaemia  weakens 
the  resistance  of  the  tissues  in  which  it  exists,  thus  furnish- 
ing the  proper  conditions  for  bacterial  infection  with  result- 
ing inflammation. 

A  study  of  hyperaemia  is,  in  reality,  a  study  of  the  vaso- 
motor  mechanism.  We  have  noted  the  fact  of  vaso-motor 
nerves  controlling  the  calibre  of  blood  vessels.  These  nerves 
are  branches  of  the  cerebro-spinal  system.  Most  of  them 
leave  the  spinal  nerves  and  pass  to  the  sympathetic  spinal 
ganglia  as  rami-communicantes  and  then  pass  up  and  down 
to  other  ganglia  of  the  sympathetic  system.  Some  fibres  re- 
turn from  the  sympathetic  to  the  spinal  nerves  and  are  dis- 
tributed to  blood  vessels  of  skin,  muscle  and  bone  in  the  area  of 
distribution  of  the  spinal  nerves.  A  few  vaso-motor  nerves  do 
not  enter  the  sympathetic  system  but  pass  directly  to  their 
destination  with  the  spinal  nerves.  Thus  two  paths  exist  by 
which  vaso-motor  impulses  reacrT  the  blood  vessels,  a  direct 
route  with  the  spinal  nerves  and  an  indirect  one  through  the 
sympathetics. 

Experimenters  have  long  noted  the  return  of  vascular 
tone  in  an  area  whose  vaso-constrictor  nerves  have  been  cut. 


PEIXCIPLES  OF  OSTEOPATHY.  91 

This  return  of  vascular  tonicity  is  supposed  to  be  due  to  the 
presence  of  a  perivascular  mechanism  which  is  capable  of 
acting  feebly  after  all  other  constrictor  influences  have  been 
paralyzed. 

So  far  as  methods  of  treatment  are  concerned,  we  have 
paid  very  little  attention  to  the  presence  of  vaso-dilator  nerves, 
but  physiologists  seem  to  prove  that  -there  are  fibres  leaving 
the  cord  with  the  posterior  roots  of  the  nerve  trunks  which 
act  as  dilators  when  irritated.  The  vaso-constrictor  nerves  are 
considered  as  constantly  in  action. 

Irritation  of  the  dilator  nerves  or  paralysis  of  the  con- 
strictors will  result  in  dilatation  of  the  arterioles,  so  that  the 
capillaries  will  be  dilated  to  their  fullest  extent.  Such  a  con- 
dition is  called  an  "active  hyperaemia."  When  the  exit  of 
the  blood  through  the  veins  is  obstructed  and  congestion  re- 
sults it  is  denoted  "passive  hyperaemia." 

Acute  or  chronic  hyperaemias  as  we  note  them  in  os- 
teopathic  practice,  are  usually  originated  by  mechanical  le- 
sions, i.  e.,  bony  displacements  which  are  either  the  result  of 
accident,  and  hence  primary  lesions,  or  due  to  the  unequal 
contraction  of  the  attached  muscles,  and  hence  secondary 
lesions. 

These  bony  and  muscular  lesions  may  also  be  the  result 
of  congestion  in  the  mucosa  of  the  intestines  caused  by  the 
presence  of  indigestible  substances. 

The  same  irritants,  mechanical,  thermal  and  chemical, 
which  are  capable  of  stimulating  muscles  to  unusual  or  unequal 
contractions  so  as  to  produce  marked  evidences  of  changed 
bony  alignment,  also  cause  such  decided  changes  in  the  calibre 
of  blood  vessels  as  to  cause  tissues  to  become  hyperaemic  or 
ischaemic. 

The  majority  of  cases  seen  by  the  osteopaths  are  chronic, 
and  the  hyperaemic  condition  has  been  developed  by  slow 
degrees.  Some  slight  but  persistent  lesion  which  shows  itself 
to  palpation  \vill  be  found  to  be  the  cause. 

If  any  hyperaemia  exists  in  the  mucosa  of  the  stomach, 
palpation  around  the  sixth  dorsal  spine  will  disclose  tender- 
ness. This  spinal  tenderness  is  probably  due  either  to  the 


92  PEINCIPLES  OF  OSTEOPATHY. 

irritation  of  the  dilator  fibres  which  accompany  the  posterior 
division  of  the  fifth  dorsal  nerve  or  to  paralysis  of  the  vaso- 
constrictors of  that  area.  The  resulting  dilatation  impinges 
on  sensory  nerves  and  causes  tenderness.  The  irritation  of 
sensory  nerves  in  the  mucosa  of  the  stomach  causes  dilata- 
tion of  blood  vessels  in  that  area  and  in  the  spinal  area  from 
which  its  sensory  nerves  arise.  The  irritation  might  have 
originated  centrally  and  then  involved  the  stomach,  thus  re- 
versing the  course  of  the  irritation.  These  reflex  hyperaemias 
are  continually  noted  in  practice,  and  it  is  through  the  re- 
flexes that  relief  is  obtained.  One  of  the  classical  experiments 
to  prove  the  reflex  action  of  vaso-motor  nerves  is  to  immerse 
one  hand  in  cold  water,  the  temperature  of  the  other  hand  will 
be  lowered  also. 

It  is  quite  generally  conceded  that  the  small  arteries  and 
arterioles  in  all  parts  of  the  body  are  supplied  with  vaso-motor 
nerves.  Their  presence  in  the  blood  vessels  of  the  brain  has 
been  recently  proven  by  G.  C.  Huber.  His  demonstration  of 
vaso-motor  nerves  in  the  cerebral  blood  vessels  explains  many 
of  the  circulatory  phenomena  resulting  from  osteopathic 
manipulations. 

Irritation  of  sensory  nerves  in  any  part  of  the  body  causes 
vascular  dilatation  in  the  irritated  area.  Physiological  ex- 
periments seem  to  prove  that  vaso-dilator  fibres  accompany 
the  sensory  nerves,  or  that  irritation  of  sensory  nerves  causes 
paralysis  of  vaso-constrictor  nerves.  Irritation  of  the  nerves 
of  one  side  of  the  body  by  pricking  with  a  pin  causes  a  rise 
of  temperature  on  that  side  and  a  decrease  on  the  unirritated 
side,  thus  demonstrating  that  vaso-dilation  follows  sensory 
irritation. 

Experiments  to  note  the  effects  of  direct  mechanical 
irritation  of  the  stomach  mucosa  demonstrate  that  dilatation 
of  gastric  blood  vessels  follows  mechanical  irritation.  The 
physiological  hyperaemia  thus  produced  is  for  purposes  of 
increased  secretion.  It  is  well  known  that  when  this  physio- 
logical congestion  is  continued  without  cessation  as  in  the  case 
when  meals  are  frequent  and  full,  the  congestion  becomes 
pathological,  and  the  secretion  of  mucus  is  rapid.  The  liver 


PEIXCIPLES   OF  OSTEOPATHY.  93 

and  intestines  become  chronically  congested  from  similar 
causes.  This  hyperaemia  leads  to  exudates  and  hyperplasia 
which  further  irritates  sensory  nerve  endings  and  continues 
the  dilatation  of  the  arterioles.  Thus  a  vicious  cycle  of 
reflexes  is  established  which  tends  to  ever  increasing  de- 
structiveness. 

When  the  sensory  nerve  terminals  in  the  stomach  are  irri- 
tated and  hyperaemia  of  the  gastric  vessels  results,  the  in- 
fluence of  the  irritation  does  not  end  with  gastric  congestion, 
i.  e.,  if  the  hyperaemia  be  excessive,  but  causes  dilatation  of 
arteries  in  the  spinal  cord  around  the  roots  of  sensory  nerves 
distributed  in  other  parts  of  the  body  which  are  supplied  by 
branches  of  the  same  nerve  trunk.  The  brain  does  not  always 
note  the  real  location  of  the  irritation.  It  may  refer  the  pain 
to  any  point  supplied  by  a  branch  of  the  nerve  trunk,  one 
of  whose  branches  is  irritated.  Thus  in  the  presence  of 
chronic  congestion  of  the  gastric  mucosa,  as  in  gastric  ca- 
tarrh, the  irritation  may  not  be  intense  enough  to  impress  the 
brain  with  a  painful  sensation,  but  a  slight  increase  of  capillary 
pressure  around  the  trunk  of  the  sixth  dorsal  nerve  such  as 
would  be  brought  about  by  digital  pressure  made  upon  the 
muscles  around  the  sixth  dorsal  spine,  would  cause  instant 
recognition  of  hyperaesthesia  by  the  patient.  Continued 
pressure  made  around  the  spine  drives  the  blood  out  and  les- 
sens the  sensitiveness.  If  hyperaemia  has  been  intense  enough 
to  cause  exudates,  pressure  increases  the  pain  the  longer  it 
is  continued,  because  the  exudates  have  affected  the  venous 
circulation  and  there  is  no  open  path  for  exit  of  the  blood. 

From  personal  experience  I  should  judge  that  it  is  quite 
probable  that  hyperaemia  occurs  along  the  whole  course  of  the 
nerve  and  the  nervi  nervorum  are  rendered  more  sensitive 
thereby.  In  case  of  absolute  neuritis,  manipulation  relieves  the 
condition  temporarily,  but  the  pain  increases  shortly  after  the 
treatment  is  given.  This  shows  that  a  condition  exists  which 
is  much  more  difficult  to  change  than  a  reflex  hyperaemia. 

Continued  hyperaemic  conditions  cause  increased  nutri- 
tion, i.  e.,  hyperplasia  of  connective  tissue.  Connective  tissue 
seems  to  be  more  readily  formed  than  any  of  the  higher  grades 


94  PRINCIPLES   OF  OSTEOPATHY. 

of  tissue.  This  may  explain  the  rapid  stiffening  of  the  spine 
in  cases  of  visceral  hyperaemia. 

The  digital  pressure  test  is  an  excellent  method  of  dif- 
ferentiating the  intensity  of  an  hyperaemia.  Even  in  cases 
of  conscious  pain  in  the  gastric  or  intestinal  areas,  it  is  pos- 
sible to  use  this  test.  In  colic,  deep  pressure  made  gradually 
will  give  relief,  but  in  cases  of  gastric  ulcer  or  other  inflam- 
matory conditions,  pressure  aggravates  the  pain. 

Therapeutics, — We  now  have  before  us  an  array  of 
physiological  facts  and  it  remains  for  us  to  indicate  how  we 
shall  use  them. 

The  osteopath  treats  the  vaso-motor  nerves  as  though 
there  were  no  dilator  fibres  to  be  reckoned  with.  Practically 
we  consider  that  the  vaso-constrictors  are  continually  acting 
to  maintain  the  "tone"  of  the  blood  vessels.  Therefore,  having 
only  this  one  force  with  which  to  reckon,  we  consider  all  dila- 
tation as  vaso-constrictor  paralysis. 

We  noted  the  fact  that  the  cutaneous  and  visceral  blood 
vessels  were  supplied  with  vaso-constrictors  and  that  vaso- 
constriction  in  the  superficial  area  was  compensated  for  by 
dilatation  in  the  deep  area. 

A  large  number  of  sensory  impressions  reaching  the  vaso- 
motor  centers  over  the  sensory  nerves  of  the  skin  usually  re- 
sult in  vaso-constriction  of  cutaneous  blood  vessels,  hence  in- 
ternal congestion.  Irritation  of  the  sensory  nerves  in  the  skin 
may  cause  muscle  under  the  skin  to  contract,  thus  obstructing 
the  circulation  in  the  skin.  Therefore,  our  manipulations  for 
vaso-motor  effects  naturally  divide  themselves  into  two  classes : 
First,  those  which  inhibit  cutaneous  reflexes ;  second,  those 
which  relax  muscle  in  order  to  remove  obstructions.  This 
division  is  purely  arbitrary  on  our  part,  but  it  serves  to  ex- 
plain our  work.  We  purposely  leave  out  of  this  discussion 
the  thought  that  we  may  have  an  osseous  lesion  causing  our 
vaso-motor  disturbance.  We  divide  the  spine  into  areas  ac- 
cording to  the  predominating  influence  which  issues  from  it, 
thus,  the  sub-occipital  fossa  is  the  first  important  area.  It  has 
long  been  know  that  pressure  applied  to  this  area  in  a  case  of 
congestive  headache  gives  great  relief.  The  good  effects  are 


PEIXCIPLES   OF  OSTEOPATHY.  95 

not  lost  when  the  pressure  is  removed.  This  proves  that  the 
effect  of  the  pressure  is  on  the  nerves  of  that  area,  and  that 
they  are  in  close  central  connection  with  the  vaso-motor  cen- 
ter in  the  medulla.  This  center  regulates  the  calibre  of  the 
arteries  all  over  the  body.  It  has  been  stated  that  pressure 
at  the  basi-occiput  retards  the  blood  flow  to  the  brain,  the 
pressure  being  on  the  vertebral  arteries.  We  believe  a  care- 
ful examination  of  the  atlas  will  convince  one  that  in  the 
average  skeleton  the  groove  for  the  vertebral  artery  is  so  deep 
and  well  protected  that  pressure  on  the  surface  of  the  neck 
cannot  affect  the  artery.  If  our  pressure  effect  is  mechanical, 
why  does  the  effect  last  so  long?  The  blood  stream  is  as 
swift  as  an  ocean  greyhound,  and  would  rush  into  the  partly 
filled  vessel  with  its  previous  force,  just  the  moment  the 
pressure  is  removed.  We  can  only  explain  the  result  by 
noting  the  fact  that  a  change  has  been  made  in  the  entire  cir- 
culation. Downward  pressure  on  the  carotids  is  also  recom- 
mended to  retard  the  blood  flow  to  the  head.  This  seems  im- 
practicable since  the  pressure  cannot  help  affecting  the  venous 
return  as  well  as  the  carotid  stream.  The  best  and  most  last- 
ing effects  are  always  vaso-motor. 

It  is  a  well  recognized  fact  in  the  osteopathic  profession 
that  pressure  in  the  suboccipital  triangles  causes  a  lessened 
blood  pressure  all  over  the  body.  This  fact  is  made  use  of 
daily  to  lower  the  temperature  of  the  body  in  cases  of  fever. 
If  pressure  had  a  mechanical  rather  than  a  nervous  effect  on 
the  circulation,  we  could  hope  for  no  general  effect,  such  as  we 
do  secure.  This  procedure  is  called  inhibiting  the  vaso-motor 
center.  Why  does  it  inhibit?  A  "vascular  tone"  is  normal 
in  the  body  in  order  to  keep  the  blood  equally  distributed. 
This  "vascular  tone"  is  easily  disturbed  since  it  acts  according 
to  the  sum  of  the  sensory  impulses  reaching  the  center  in 
the  medulla.  Pressure  in  the  suboccipital  triangles  affects  not 
only  the  sum  of  the  stimuli  reaching  the  center,  but,  most  im- 
portant of  all,  affects  the  capillary  circulation  in  this  area 
which  is  in  close  nervous  and  circulatory  connection  with  the 
medulla.  Any  external  application,  such  as  hot  or  cold  water, 
local  anaesthetics  or  counter-irritants  must  secure  whatever 


96  PRINCIPLES  OF  OSTEOPATHY. 

internal  change  may  be  manifested,  by  the  effect  these  thera- 
peutic procedures  may  have  on  cutaneous  nerves. 

Pressure  in  the  sub-occipital  triangles  will  relax  the  struc- 
tures forming  those  triangles,  thus  lessening  the  sensory  im- 
pulses entering  the  center  from  that  source.  The  relaxed 
structures  will  hold  more  blood,  hence  they  will  in  a  slight 
degree  relieve  congestion  of  the  center. 

These  triangles  are  the  bilateral  surface  centers  in  which 
we  operate  to  cause  dilatation  of  vessels  in  the  skin  of  the 
trunk  and  extremities.  We  inhibit  vaso-constriction  of  sur- 
face arteries. 

The  next  great  constrictor  area  is  the  splanchnic,  sixth 
to  eleventh  dorsal.  This  and  the  preceding  area  are  the  two 
points  of  vantage  for  the  osteopath.  Since  the  splanchnic 
nerves  control  a  system  of  blood  vessels  whose  combined  ca- 
pacity is  equal  to  the  entire  amount  of  the  blood  in  the  body, 
we  can  quickly  realize  what  it  means  to  the  general  circula- 
tion to  affect  this  area.  In  all  cases  of  congestive  headaches, 
fever,  hyperaemia  of  visceral  organs,  etc.,  we  "inhibit  the 
splanchnics."  Why?  The  reflexes  between  the  skin  of  the 
back  and  the  muscles  of  the  back  are  so  intense  that  they  cause 
vascular  constriction  of  the  cutaneous  arteries  and  contraction 
of  the  deep  muscles  of  the  back,  thus  adding  a  mechanical 
obstruction  to  the  circulation  of  the  blood  in  an  already  con- 
stricted area.  Is  it  not  possible,  yea,  probable,  that  this  state 
of  the  surface  tissue  causes  a  congestion  of  the  vaso-motor 
centers  in  the  dorsal  area  of  the  cord,  thus  nullifying  their  con- 
trol of  the  splanchnic  area  ?  Such  a  condition  might  be  brought 
about  by  cold.  The  eating  of  indigestible  food  which  remains 
a  long  time  in  the  digestive  tract  may  also  be  a  cause. 

The  facts  are  as  we  have  stated  them,  we  inhibit  over  the 
splanchnic  area  to  lessen  the  intensity  of  the  reflexes  in  that 
area,  thereby  allowing  the  centers  to  regain  their  control. 
Remember  that  inhibition  lessens  the  sensory  impressions 
reaching  a  center  and  relaxes  muscle  both  directly  and  indi- 
rectly. 

Case  Illustrations. — An  illustration  of  osteopathic 
methods  applied  to  hyperaemia  is  afforded  by  the  following 


PKINCIPLES   OF   OSTEOPATHY.  97 

case:  A  gentleman  about  fifty  years  of  age  was  inspecting 
mines  in  the  vicinity  of  Yuma,  Arizona.  He  was  of  plethoric 
habit  and  hence  the  heat  of  that  locality  affected  him  quickly. 
About  eight  P.  M.,  while  in  his  tent  preparing  to  bathe  in 
order  to  get  some  relief  from  the  intense  heat,  he  felt  a  wave 
of  weakness  pass  up  his  left  side  and  almost  instantly  power 
of  motion  on  that  side  was  lost.  Paralysis  did  not  extend  to 
the  face.  The  gentleman  was  brought  to  Los  Angeles  and 
came  under  the  best  of  medical  treatment.  Electricity  and 
massage  were  tried  with  fair  success,  but  the  left  arm  and 
hand  remained  helpless  and  were  carried  in  a  sling.  The  hand 
was  badly  swollen  and  would  pit  under  pressure,  thus  showing 
a  marked  degree  of  vaso-constrictor  paralysis.  The  hand  and 
arm  had  been  thoroughly  massaged  for  two  months  before 
osteopathic  treatment  was  given.  One  hour's  seance  with  the 
masseur  would  make  a  wonderful  change  in  the  hand,  but 
the  oedematous  condition  returned  in  a  few  hours.  The  fingers 
were  bent  into  the  palm,  showing  a  marked  tendency  to  a 
spastic  condition. 

From  the  medical  standpoint  it  was  considered  sufficient 
for  this  case  to  have  the  local  massage  of  the  arm  and  hand, 
with  administration  of  strychnine. 

The  osteopathic  examination  was  made  at  the  end  of  two 
months  of  the  treatment  just  outlined.  Slight  signs  of  paraly- 
sis were  noted  at  the  angle  of  the  mouth  on  the  hemiplegic 
side.  Examination  of  the  neck  showed  marked  contraction  of 
the  deep  cervical  muscles  on  the  left  side,  extending  from  the 
occiput  to  the  fourth  cervical  vertebra.  Moderate  digital  pres- 
sure over  these  contracted  muscles  caused  pain.  There  was 
also  some  tenderness  as  low  as  the  sixth  dorsal  spine.  The 
intense  contraction  and  tenderness  in  the  upper  cervical  region 
was  noted  as  a  secondary  lesion  existing  as  a  result  of  a  blood 
clot.  It  was  reasoned  that  if  these  contracted  muscles  could 
be  relaxed  cerebral  circulation  would  be  equalized  and  more 
rapid  absorption  of  the  clot  made  possible.  The  spinal  tender- 
ness was  brought  about  by  the  same  law  of  irritation  of  sen- 
sory nerves  we  have  previously  stated.  There  was  a  dilated 
condition  of  the  arterioles  around  the  roots  of  the  sensory 


98  PBINCIPLES  OF  OSTEOPATHY. 

nerves  in  the  cord  similar  in  character  to  that  which  existed  at 
the  peripheral  distribution  of  these  nerves,  especially  in  the 
hand.  There  was  decided  wrist  and  elbow  reflex,  showing  that 
the  subsidiary  nerve  cells  in  the  cord  were  intact,  but  that  either 
the  cerebral  motor  areas  or  some  part  of  their  connecting  paths 
were  injured.  The  vascular  tone  of  blood  vessels  in  all  other 
parts  of  the  body  was  good,  showing  that  the  chief  vaso-motor 
center  in  the  medulla  was  acting.  Here  was  a  case  showing 
a  perfect  reflex  in  the  arm  but  loss  of  ability  to  will  a  mo- 
tion ;  perfect  sensation  and  vaso-motor  paralysis. 

Treatment  was  directed  to  securing  relaxation  of  the  con- 
tracted cervical  muscles  and  to  break  up  adhesions  in  the 
shoulder  joint  which  had  been  allowed  to  stiffen.  No  treat- 
ment was  given  to  the  hand  or  arm.  The  patient  was  in- 
structed to  straighten  the  bent  fingers  with  the  well  hand  many 
times  per  day  to  overcome  the  spastic  condition.  Vaso-motor 
tone  returned  to  the  blood  vessels  of  the  hand  in  proportion 
to  the  amount  of  cervical  relaxation  accomplished.  At  the  end 
of  one  month  the  hand  was  allowed  to  hang  naturally,  and 
scarcely  any  oedema  was  noticeable.  Muscular  control  and 
power  have  steadily  increased. 

Another  illustration  is  afforded  by  the  following  case :  A 
gentleman  suffering  with  inflammatory  rheumatism  in  the 
second  toe  of  the  right  foot  sought  relief  by  means  of  osteo- 
pathic  treatment.  He  had  used  the  salicylates  in  his  previous 
attacks,  but  his  stomach  had  become  intolerant  of  them.  The 
toe  was  red  and  angry  looking,  throbbing  with  pain  and 
swollen  to  the  size  of  the  great  toe. 

Examination  of  the  spine  revealed  tenderness  between  the 
fifth  lumbar  and  third  sacral  spines,  also  between  the  second 
and  third  lumbar  spines.  Why  should  tenderness  exist  at 
these  points?  The  answer  according  to  anatomy  and  physiol- 
ogy is  that  these  spinal  areas  mark  the  point  of  emergence 
from  the  spinal  column  of  the  anterior  crural  and  great  sciatic 
nerves  which  are  distributed  to  equal  parts  of  the  affected  toe. 
The  sensory  nerves  being  irritated  by  the  deposit  of  faulty 
katabolic  products  in  the  tissues  of  the  toe  as  the  result  of  a 
slow  blood  stream.  In  this  case  the  patient  was  caught  out 


PRINCIPLES  OF  OSTEOPATHY.  99 

in  the  rain  and  got  his  feet  wet.  The  peripheral  irritation 
of  the  sensory  nerves  caused  dilatation  of  the  arterioles  and 
capillaries.  The  blood  vessels  around  the  roots  of  other  sen- 
sory nerves  which  were  branches  of  the  same  nerve  trunks 
also  dilated  in  response  to  this  irritation,  i.  e.,  hyperaemia  in 
the  spinal  cord  was  brought  about  at  the  point  of  origin  of 
the  anterior  crural  and  great  sciatic  nerves,  hence  the  sensory 
nerves  to  the  skin  and  muscles  of  the  back  which  are  innervated 
from  the  same  area  of  the  cord  as  these  great  nerve  trunks 
will  also  be  tender  to  increased  tension  such  as  that  secured  by 
the  digital  pressure. 

In  a  case  such  as  this  we  do  not  desire  to  have  the  deposit 
in  the  toe  taken  up  until  the  eliminating  organs  of  the  body 
are  acting  freely.  To  force  it  into  the  circulation  before  such 
time  as  it  can  be  eliminated  may  result  in  inflaming  another 
part.  It  is  quite  necessary  that  the  throbbing  pain  be  subdued 
so  that  sleep  may  be  had.  The  patient  soon  learns  to  take  ad- 
vantage of  venous  circulation  by  elevating  the  foot.  If  pres- 
sure upon  and  a  gentle  relaxing  movement  of  the  muscles  in 
the  spinal  area  is  made,  there  will  quickly  be  noted  a  decrease 
in  spinal  sensitiveness  followed  by  lessened  conscious  oain  in 
the  toe.  It  is  quite  probable  that  pain  in  the  toe  is  due  to 
hyperaemia ;  sensitiveness  in  the  spinal  area  is  due  to  the  same 
sort  of  condition,  the  difference  being  in  degree.  It  is  impos- 
sible to  prove  the  presence  of  these  transitory  hyperaemias  by 
any  direct  observations  any  more  than  it  is  possible  to  prove 
by  post  mortem  examination  that  hyperaemia  or  anaemia  of 
the  brain  is  present  as  a  fixed  pathological  lesion  in  faulty  func- 
tioning of  the  brain. 

Pressure  and  relaxation  in  the  spinal  area  draws  the  blood 
away  from  its  position  around  the  nerve  trunk  roots  and  thus 
stops  many  of  the  impulses  which  would  originate  centrally  as 
a  result  of  the  irritation  of  sensory  roots  of  the  nerve  trunk. 

We  usually  think  of  these  reflex  sensitive  areas  of  the 
spine  as  being  evidence  of  trie  ability  of  all  the  branches  of 
a  nerve  trunk  to  express  some  degree  of  the  irritation  being 
brought  to  bear  on  any  one  of  the  branches.  It  seems  to  me 
that  in  the  light  of  what  is  known  to  happen  in  the  area  of 


ioo  PK1NCIPLES  OF  OSTEOPATHY. 

an  irritated  nerve,  hyperaemia,  that  the  same  change  in  cir- 
culation may  occur  around  the  roots  of  its  parent  nerve  trunk 
and  be  the  sole  reason  for  what  we  denominate  a  renex  pain. 
By  giving  the  heavy  movement  required  to  replace  a  sub- 
luxated  vertebra  or  even  to  relax  tense  muscles  around  an 
otherwise  normal  articulation,  it  is  quite  probable  that  inex- 
plicable changes  are  wrought  in  the  circulation  at  these  points 
which  immediately  changes  the  character  of  the  nerve  impulses 
originating  or  reflexing  from  this  portion  of  the  spinal  cord. 


CHAPTER    V. 


SECRETORY  TISSUE. 

Metabolism. — One  of  the  attributes  of  the  primitive 
cell  is  metabolism.  We  find  it  exemplified  in  the  activity  of 
those  epithelial  cells  which  are  known  under  the  general  clas- 
sification of  secretory  tissues.  When  studied  under  the  micro- 
scope their  protoplasm  exhibits  definite  changes.  The  cell  may 
not  show  any  decided  change  in  form,  but  the  protoplasm 
manifests  a  change  in  its  molecular  composition. 

The  terms  "gland"'  and  "secretion"  are  very  indefinite.  Since 
it  is  possible  that  all  tissues  may  give  off  secretions  which  are  in 
some  degree  comparable  to  those  discharged  into  the  blood 
by  the  thyroid  or  adrenals,  it  is  evident  that  the  designation 
of  secretory  tissue  as  the  representative  of  cell  metabolism 
may  be  far  short  of  the  actual  facts.  However,  the  metabolism 
in  secretory  cells  of  glands  which  discharge  their  secretion 
on  the  surface  can  be  readily  studied.  The  knowledge  of 
metabolic  processes  in  the  ductless  glands  is  arrived  at  mainly 
by  deduction. 

Epithelium. — By  right  of  age  and  extent  of  distribu- 
tion secretory  tissues  should  have  held  first  place  in  this  series 
of  chapters  on  the  Principles  of  Osteopathy.  Secretory  cells 


PEIXCIPLES  OF  OSTEOPATHY.  101 

are  epithelial.  Epithelial  cells  are  the  oldest  in  the  body. 
There  are  animals  which  have  no  other  kind  of  tissue.  The 
first  stages  in  the  development  of  our  own  bodies  are  marked 
by  the  presence  of  two  layers  of  epithelial  tissue,  the  ectoderm 
and  endoderm.  Less  histological  change  has  occurred  in 
epithelial  cells  than  in  any  other  tissues  of  the  body.  In  other 
tissues  we  find  the  original  form  of  the  cells  almost  or  com- 
pletely lost.  It  has  become  subordinate  to  the  functional  activ- 
ity of  that  which  its  activity  has  secreted.  For  example,  we 
note  the  development  of  a  muscle  fiber.  The  original  cell 
secretes  "specific  muscle  substance"  upon  its  surface.  Just 
in  proportion  to  the  functional  activity  of  the  "specific  mus- 
cle substance"  do  we  find  the  original  cell  structure  subordin- 
ate. Plain  muscle  fibers  show  merely  a  change  in  the  form  of 
the  original  cell.  No  striations  have  been  formed.  Heart 
muscle  cells  have  secreted  more  "specific  muscle  substance" 
arranged  in  fibers,  the  nucleus  and  protoplasm  have  been 
crowded  to  one  side  by  the  structure  which  they  have  created. 
The  completely  striated  muscle  almost  entirely  supplants  that 
which  created  it.  Its  nucleus  and  surrounding  protoplasm 
are  obscured. 

We  have  noted  how  the  original  cells  of  our  bodies  have 
gradually  surrendered  various  activities  which  the  parent  cell 
possessed.  For  each  one  to  have  retained  all  these  character- 
istics would  have  resulted  in  mere  bulk  of  tissue  and  each 
cell  would  have  hindered  the  others.  The  differing  products 
of  protoplasmic  activity  have  resulted  in  a  specialization  of 
tissues  which  makes  for  harmony  and  completeness. 


Fig.   26. — Stratified  squamous  epithelium   from  human  mouth. 
Drawn  by  A.  M.  Hewitt. 

Protective  Epithelium. — As  before  mentioned,  epi- 
thelial cells  show  less  histological  change  than  other  tissue 
cells.  The  original  embryonal  layers  were  epithelial,  both 


102 


PEINCIPLES  OF  OSTEOPATHY. 


layers  having  an  external  surface.  The  epithelial  cells  form 
a  protective  covering,  the  skin.  We  find  them  forming  the 
lining  of  the  respiratory,  digestive  and  renal  tracts.  In  all 
these  situations  probably  the  first  duty  is  protection.  Removal 
of  epithelium  results  in  inflammation  which  continues  until  re- 
generation occurs.  Destruction  of  considerable  areas  of  epi- 
thelium, as  by  burns,  may  expose  so  many  nerve  endings  that 
death  results.  Thinness  of  this  covering  has  given  rise  to  the 
expression,  "her  nerves  are  very  near  the  surface,"  meaning 
that  the  nerves  are  easily  stimulated. 


Fig.    27. — Ciliated   columnar   epithelium,   vas  epididymis. 
Drawn  by  J.  E'  Stuart,  D.  O. 

Secretory  Epithelium. — The  position  of  epithelium  on 
the  surfaces  of  the  body  compels  it  to  serve  other  purposes 
than  protection.  The  katabolic  products  from  the  deep  tissues 
must  be  passed  to  the  surface  and  cast  off  by  the  epithelial 
cells,  likewise  all  anabolic  material  for  the  life  and  growth 
of  internal  cells  must  be  taken  up  by  these  surface  cells. 
Most  of  the  food  material  needs  to  be  dissolved  and  chemically 
changed  before  being  fit  for  the  use  of  internal  cells,  there- 
fore certain  cells  throw  out  protoplasmic  products  which  bring 
about  the  proper  changes  in  the  food  materials.  As  a  result 
of  these  various  duties  performed  by  epithelial  cells  we  have 
the  words  "excretory"  and  "secretory,"  both  coming  under  the 
general  head  glandular  epithelia,  or  as  we  have  entitled  this 
chapter,  secretory  tissue. 

Sensory  Epithelium. — .  A  third  duty  of  epithelial  tis- 
sues is  to  receive  impressions  from  the  outside  world,  and 
stimulate  sensation.  The  functions  of  seeing,  hearing,  tast- 


PKIXCIPLES   OF   OSTEOPATHY. 


103 


ing,  smelling  and  touching  are  dependent  on  special  arrange- 
ments of  epithelial  cells  called  sensory  epithelia. 


Fig.    28. — Section   of   ileum   of   a   cat   showing  glandular   epithelia. 
Drawn  by  A.  M.  Hewitt. 

Gland     Formation. — The     simplest     arrangement     of 
glandular  epithelium  is   found  where  "gland  cells"   are  scat- 


-  -  - .,  */-.-.-•/ —  '  •  -..,..•.      ••..«-• 

:.-S^V-J.-'l  -•"  v.  •  ..  ••,'fft.^.  •'.''•'"  .-•'.'  •'.-  ._-•-, .      •;     ;      .  ,    ',  '•  '  ~-^-~^    '•'  •   r*~'.  -'  s  ". '  '  •  V 


Fig.  29. — Retina  of  a  cat's  eye  showing  sensory  epithelia.     Drawn  by  A.  M.  Hewitt. 

tered  here  and  there  among  the  ordinary  epithelial.     For  ex- 
ample, the  goblet  cells  found  in  the  mucous  membrane.      The 


104  PRINCIPLES  OF  OSTEOPATHY. 

protoplasm  of  these  goblet  cells  produces  the  slimy  substance 
known  as  "mucus."  The  mucus  is  accumulated  within  the  cell 
capsule  until  the  tension  becomes  so  great  that  the  capsule 
breaks  and  the  protoplasmic  product  is  discharged  upon  the 
surface  of  the  membrane.  When  the  cells  of  protective  epi- 
thelium are  sufficiently  interspersed  with  gland  cells  it  is 
called  a  glandular  membrane.  A  vertical  section  of  such  a 
membrane  shows  the  "goblet  cells"  crowded  away  from  the 
surface  but  a  slender  prolongation  gives  them  access  to  it. 
When  many  glandular  cells  are  collected  together,  invagination 
occurs,  thus  increasing  the  extent  of  surface.  Such  a  forma- 
tion is  called  a  multicellular  gland.  This  method  of  invagina- 
tion may  cease  in  its  simple  tubular  form,  or  proceed  to  the 
formation  of  extensive  organs  like  the  salivary  glands,  pan- 
creas or  liver. 

Sexual  Cells. — The  sexual  cells -are  found  among  epi- 
thelial cells.  Since  epithelial  tissue  is  the  oldest  and  the  least 
changed,  it  is  not  surprising  that  sexual  cells  should  be  found 
generated  in  relation  with  this  form  of  tissue.  Sexual  cells 
tend  to  form  invaginations  similar  to  those  formed  by  glandu- 
lar cells,  hence  the  use  of  the  term  sexual  glands. 

Summary. — Since  we  find  that  epithelial  tissue  acts  as 
a  protection  to  all  other  tissues,  that  excretion  and  secretion 
are  carried  on  by  it,  that  some  cells  are  so  highly  specialized 
that  our  special  senses  are  dependent  upon  them,  we  realize 
how  extensively  we  depend  upon  the  integrity  of  this  tissue. 
Its  position  at  once  places  it  in  relation  with  external  stimuli 
and  internal  activity.  It  is  most  closely  associated  with  the 
central  nervous  system,  therefore  we  can  expect  to  secure  far- 
reaching  results  by  bringing  our  therapeutic  methods  to  bear 
on  this  surface  tissue. 

Arrangement  of  Gland  Cells. — We  will  consider  only 
those  glands  which  give  off  an  external  secretion.  They  con- 
sist of  epithelial  cells  arranged  with  definite  relations  to  a  base- 
ment membrane,  on  the  other  side  of  which  is  placed  a  net 
work  of  blood  vessels.  The  secretion  is  selected  from  the 
lymph  which  bathes  the  cells,  and  is  poured  out  on  the  free 
surface. 


PRINCIPLES  OF  OSTEOPATHY.  105 

All  glands  have  the  general  structure  just  described  but 
are  oftentimes  complicated  in  arrangement  to  suit  the  special 
function  required.  Just  as  the  arrangement  of  glands  varies, 
their  secretions  also  vary. 

Filtration,  Osmosis  and  Diffusion. — If  we  go  back  to 
the  early  study  of  secretory  tissues  we  find  the  investigators 
describing  secretion  as  a  process  of  filtration,  osmosis  or  dif- 
fusion. The  basement  membrane  was  supposed  to  affect  the 
liquids  passing  through  it,  the  differences  in  its  intricate  struc- 
ture accounting  for  the  differences  in  the  various  secretions. 
The  explanations  of  all  physiological  processes  have  been  at 
one  time  expounded  on  a  purely  physical  basis.  Text 
books  of  ten  years  ago  had  very  little  to  say  in  support  of 
selective  power  of  secretory  cells.  They  were  given  an  entirely 
passive  roll.  Our  modern  text  books  lay  great  stress  on  the 
part  played  by  individual  cells  in  the  production  of  the 
characteristic  secretions  of  definite  glands.  Close  study  of 
nerve  endings  when  stained  by  the  golgi  method  has  re- 
vealed the  wealth  of  nerve  arborizations  around  epithelial  cells. 
Thus  it  is  noted  that  each  cell  is  an  important  active  unit  in 
the  work  of  the  gland  and  that  its  perfect  work  is  necessary 
for  the  successful  action  of  the  gland  as  a  whole.  Without 
our  knowledge  of  this  intimate  connection  between  individual 
cells  and  the  nervous  system  it  would  be  hard  to  comprehend 
the  physiological  action  of  glands.  So  long  as  our  knowledge 
took  cognizance  only  of  the  general  relation  of  cell  to  base- 
ment membrane  and  blood  supply  it  was  thought  that  the  phe- 
nomena of  filtration,  osmosis  and  diffusion  were  sufficient  ex- 
planation. If  this  were  all,  then  vaso-motion,  which  regu- 
lates blood  pressure,  would  be  the  mechanism  by  which  secre- 
tion is  controlled. 

The  Individual  Cell. — Physiologists  had  observed 
phenomena  which  were  not  explainable  by  the  methods  just 
mentioned.  The  pressures  in  the  blood  and  secretions  did  not 
bear  the  proper  relations  to  each  other,  in  fact  they  were  re- 
versed, this  necessitated  a  complete  reconstruction  of  theories 
in  regard  to  secretion.  The  individual  cell  now  takes  its  po- 
sition as  a  vital  factor  in  the  activity  of  the  gland  and  it  acts, 


106  PRINCIPLES   OF  OSTEOPATHY. 

not  according  to  blood  pressure  on  the  hither  side  of  its  base- 
ment membrane,  but  according  to  the  governing  impulse  which 
reaches  it  over  a  nerve  fiber  which  proceeds  from  a  center  of 
control.  This  center  of  normal  control  acts  according  to  the 
sum  of  the  stimuli  reaching  it  from  other  centers. 

Secretory  Fibers. — It  is  practically  impossible  to  de- 
monstrate the  presence  of  secretory  fibers  to  all  glands.  It 
is  difficult  to  separate  the  vaso-motor  and  secretory  fibers 
even  in  those  glands  where  the  dual  action  is  best  demon- 
strated. Since  true  secretory  fibers  are  known  to  exist  in 
a  few  cases,  physiologists  are  not  slow  to  concede  the  proba- 
bility that  they  are  present  in  all  cases. 

The  microscope  is  able  to  demonstrate  the  direct  partici- 
pation of  certain  epithelial  cells  in  the  formation  of  the  se- 
cretion from  certain  glands.  The  goblet  cells  can  be  studied 
as  they  discharge  their  mucous  on  the  surface,  likewise  the 
cells  in  sebaceous  and  mammary  glands. 

It  is  quite  probable  that  not  only  the  organic  constituents 
of  the  secretions,  but  the  amount  of  water  and  salts  also  are 
under  the  control  of  secretory  nerves.  For  the  experiments 
upon  which  these  statements  are  based  any  of  the  recent 
physiological  text  books  will  furnish  the  data. 

The  New  View-point. — The  students  of  ten  years  ago 
who  studied  carefully  the  phenomena  of  diffusion,  osmosis  or 
filtration  find  now  very  little  emphasis  placed  upon  these 
physical  explanations  of  the  phenomena  of  respiration,  ab- 
sorption or  secretion.  A  new  physiological  view-point  has 
been  formed  which  gives  to  the  individual  cells  an  import- 
ance hitherto  ignored,  and  likewise  gives  us  understanding  of 
the  far-reaching  control  of  the  nervous  system,  which  makes 
us  conscious  of  the  fact  that  we  are  not  a  collection  of  me- 
chanical devices  exemplifying  physical  laws  but  a  co-ordi- 
nated mechanism,  essentially  vital,  acting  according  to  psy- 
chical as  well  as  mechanical,  thermal  and  chemical  stimuli. 

When  we  have  thoroughly  incorporated  in  our  minds 
the  fact  that  the  phenomena  manifested  in  the  manifold  activi- 
ties of  our  bodies  have  a  vital  and  a  physical  side  we  are 
prepared  to  study  physiology  without  losing  our  balance  be- 


PRINCIPLES  OF  OSTEOPATHY.  107 

cause  of  fixing  our  attention  too  much  on  one  side  or  the 
other. 

Necessary  Conditions  for  Secretion. — Every  gland  re- 
quires four  conditions  for  its  proper  activity;  (i)  proper 
structure,  i.  e.,  it  must  have  inherited  normal  power;  (2) 
unimpeded  blood  supply;  (3)  the  normal  elements  of  its  se- 
cretion must  be  in  its  blood  supply;  (4)  perfect  nerve  con- 
trol. 

As  physicians  we  view  every  perversion  of  secretory  tissue 
in  the  light  of  these  four  requisites  for  perfect  action. 

If  the  first  condition  exists  we  can  do  nothing  toward 
remedying  the  deficiency  but  in  some  cases  we  can  supply  a 
substitute  for  the  normal  secretion  of  the  defective  glands. 
Sebaceous  glands  are  frequently  lacking  and  hence  the  skin 
is  dry  and  harsh.  It  is  the  duty  of  the  physician  to  supply 
a  substitute  for  the  product  of  these  glands. 

Classes  of  Drugs  Which  Affect  Secretion. — Nearly  all 
diseases  are  characterized  by  some  excess,  defect  or  perversion 
of  secretion  and  the  major  portion  of  therapeutic  procedures 
are  directly  addressed  to  the  alleviation  of  these  conditions. 
Drug  therapy  is  dependent  on  the  action  of  chemicals  to 
right  the  difficulties.  We  have  only  to  note  the  names  of 
classes  of  drugs  to  realize  how  extensively  they  are  used  to 
control  secretion.  Astringents,  tonics,  cathartics,  diuretics,^ 
diaphoretics,  expectorants,  emmenagogues,  sialagogues,  er- 
rhines,  etc.,  each  drug  in  every  class  being  a  more  or  less 
intense  poison.  If  it  were  not  poisonous  it  would  not  act  so 
promptly.  It  is  not  a  food,  hence  cannot  become  incorporated 
in  the  protoplasm  of  the  body  cells.  Being  a  foreign  sub- 
stance, our  bodies  attempt  to  dissolve  and  eliminate  it.  Why 
pilocarpin  is  eliminated  in  the  saliva  and  sweat  in  preference 
to  the  alimentary  tract  or  kidneys  is  difficult  to  explain  but 
the  fact  that  it  is  forced  out  of  the  body  as  quickly  as  pos- 
sible ought  to  be  sufficient  evidence  against  using  it.  Drugs 
which  promote  secretion,  do  so  at  the  expense  of  the  vitality 
of  the  body.  They  call  forth  an  excessive  amount  of  energy 
in  order  to  be  ejected  from  the  body. 

It  seems  to  us  that  a  sufficient  number  of  cases  have  been 


io8  PKIXCIPLES  OF  OSTEOPATHY. 

treated   successfully  by  physiological   means  to  warrant  the 
cessation  of  the  use  of  drugs. 

Unimpeded  Blood  Supply. — The  second  necessary  con- 
dition for  normal  secretory  activity  has  been  stated  as  an  un- 
impeded blood  supply.  This  is  a  prerequisite  for  good  func- 
tioning which  cannot  be  ignored.  This  question  of  circula- 
tion is  the  basis  of  osteopathic  practice,  therefore  we  examine 
every  case  with  special  attention,  knowing  that  if  the  proper 
amount  of  blood  is  not  furnished  to  the  secretory  tissues, 
under  a  proper  speed  and  tension,  improper  function- 
ing will  result.  We  know  that  the  blood  stream  is  subject  to 
many  influences  of  a  mechanical  character,  external  pressures 
exerted  by  subluxated  bones,  contracted  muscles,  etc.,  but  far 
in  excess  of  these  purely  structural  difficulties  we  find  that  the 
influence  of  vaso-motor  nerves  is  a  condition  which  requires 
our  attention.  Secretory  cells  depend  on  the  blood  being 
brought  to  them  under  a  certain  pressure  and  speed.  These 
conditions  of  the  blood  stream  are  governed  largely  by  the 
vaso-motors.  Vaso-motors  act  according  to  stimuli  reaching 
their  governing  centers  over  sensory  nerves  ending  in  all 
the  body  tissues,  but  principally  those  ending  in  skin,  mucous 
membrane  and  muscle.  These  sensory  nerves  are  subject  to 
mechanical,  thermal  and  chemical  stimuli.  Therefore  our 
search  for  causes  of  abnormal  secretion  compels  us  to  investi- 
gate not  only  the  prominent  symptoms  of  the  case  but  to  note 
the  structural  conditions  along  the  course  of  the  nerves  which 
control  the  secretory  tissue.  Palpation  will  usually  discover 
some  lesion  which  is  the  result  of  intense  mechanical,  thermal 
or  chemical  stimulation.  The  history  of  the  case  will  fre- 
quently aid  us  in  learning  what  the  original  stimulus  was. 

Proper  Food. — The  third  prerequisite  for  perfect  se- 
cretion is  the  presence  of  proper  elements  in  the  blood  to 
supply  the  needs  of  the  secretory  cells.  The  cases  are  very 
few  in  which  the  blood  does  not  contain  sufficient  materials  out 
of  which  the  secretion  may  be  formed.  The  secretion  of  the 
mammary  glands  requires  large  amounts  of  proper  food  ma- 
terial in  their  blood  supply.  The  treatment  of  defective  or 
perverted  mammary  activity  is  frequently  dietetic.  After  all 


PKIXCIPLES  OF  OSTEOPATHY.  109 

obstructions  to  the  blood  supply  have  been  removed,  the  quality 
of  the  blood  must  be  considered.  Quality,  elaboration  being 
normal,  depends  on  the  food  eaten. 

Innervation. — The  last  condition,  not  in  order  of  im- 
portance, necessary  for  proper  secretion,  is  proper  innervation. 
This  fact  is  the  recent  addition  to  our  knowledge  of  the 
mechanism  of  secretion.  Its  great  importance  can  be  grasped 
in  an  instant  and  makes  the  osteopathic  idea  of  secretion  and 
its  control  appear  decidedly  rational. 

Many  phenomena  heretofore  unexplainable  are  now  clearly 
understood  by  physiologists.  So  long  as  secretion  was  be- 
lieved to  be  controlled  by  vaso-motor  nerves  it  was  difficult 
to  account  for  the  lack  of  perspiration  while  the  blood  vessels 
of  the  skin  are  full  of  blood,  or  why  the  skin  should  perspire 
when  pallid  and  bloodless. 

Knowledge  of  secretory  nerves  has  been  in  the  posses- 
sion of  scientists  for  fifty  years.  In  1851  Ludwig  demon- 
strated that  stimulation  of  the  chorda  tympani  nerve  caused 
a  rapid  secretion  from  the  submaxillary  gland.  Beginning 
with  this  important  discovery  experiments  have  been  made  to 
confirm  a  like  control  to  other  glands.  Sufficient  proof  has 
been  secured  to  establish  nerve  control  as  one  of  the  important 
factors  in  the  activity  of  secretory  tissue. 

The  secretory  and  vaso-motor  nerves  are  usually  in  the 
same  nerve  bundle,  hence  experimentation  with  them  inde- 
pendently is  a  difficult  matter.  The  structural  lesions  found 
in  connection  with  the  perverted  secretion  usually  exert  an 
equal  influence  on  both  sets  of  nerves.  It  appears  that  both 
sets  of  nerves  are  not  equally  responsive  to  thermal  or  chemical 
stimuli  as  may  be  noted  by  the  clinical  picture  of  fever,  hot 
dry  skin.  The  addition  of  heat  for  therapeutic  purposes  suc- 
ceeds in  arousing  the  secretory  cells  in  the  skin  and  perspira- 
tion starts.  The  use  of  heat  to  excite  perspiration  is  an  ex- 
cellent therapeutic  procedure.  It  affects  secretion  reflexly,  i. 
e.,  the  sensory  nerves  of  skin  convey  impressions  to  the  cen- 
tral nervous  system  and  then  a  change  in  the  tension  of  the 
blood  vessels  on  the  surface  takes  place,  together  with  an 
increase  in  the  activity  of  the  sweat  glands. 


I  io  PEINCIPLES  OF  OSTEOPATHY. 

Osteopathic  Pathology. — Since  so  much  is  said  about 
the  necessity  for  a  perfect  circulation  our  readers  may  gain 
the  impression  that  osteopathic  pathology  is  entirely  "humoral"  \  ,_ 
in  character.     We  do  not  wish  this  idea  to  become  fixed  in  /,' 
your   minds.     It   is   sufficient   to   call   your   attention   to   the 
stress  put  upon  the  facts  set  forth  in  this  chapter  that  the  in- 
egrity  of  the  individual  cell  is  all  important,  that  the  individual 
cells  are  governed  by  nerve  influence,  and  if  this  influence  be 
perverted  they  may  refuse  that  which  is  brought  to  them  by 
the  blood.     The  fact  that  all  cells  can  secrete  while  blood  ves- 
sels are  tied  and  some  times  fail  to  secrete  when  blood  vessels 
are  full,  demonstrates  a  two- fold  influence  controlling  secre- 
tion, one  over  the  cell,  the  other  over  the  blood  vessel.     Thus   \ 
we  note  that  osteopathic  pathology  is  as  much  "cellular"  as 
"humoral." 

Therapeutics. — Having  taken  this  general  view  of  the 
conditions  necessary  for  normal  secretory  activity  we  may 
note  some  of  the  general  principles  of  therapeutics  used  to 
correct  abnormalities. 

First,  the  blood  must  circulate  actively  in  order  to  main- 
tain its  vitality.  Sluggishly  moving  blood,  as  in  conditions 
where  venous  circulation  is  interfered  with,  is  not  conducive 
to  good  secretion. 

Second,  a  moderate  increase  in  the  circulation  in  a  gland 
usually  increases  its  activity,  i.  e.,  vascularity,  within  certain 
limits  is  conducive  to  perfect  physiological  action. 

Our  therapeutics  comprehend  the  safest  and  hence  the 
best  means  of  regulating  the  circulation  in  secretory  tissues. 

There  is  no  doubt  that  the  pharmacopeia  records  many 
drugs  whose  action  is  rapid  and  effective  so  far  as  securing 
activity  or  decrease  of  secretion  is  concerned,  but  the  element 
of  danger,  i.  e.,  their  destructive  power  is  great.  Often- 
times their  action  does  not  stop  at  the  point  desired  or  limit 
its  effect  to  the  therapeutic  action  sought. 

Direct  Manipulation. — The  simplest  way  of  increasing 
the  amount  of  blood  in  a  secretory  tissue  is  by  direct  manipu- 
lation. Simple  massage  of  a  mammary  gland  will  greatly  in- 
crease the  amount  of  blood  in  it.  This  direct  manipulation  is 


PRINCIPLES   OF   OSTEOPATHY.  in 

only  transitory  in  its  effect  and  hence  not  used  by  the  osteo- 
path. 

Hyperaemia  of  the  Governing  Center. — Stimulation  of 
the  circulation  in  a  gland  may  be  secured  by  increasing  the 
amount  of  blood  in  its  governing  center  in  the  nervous  system. 
In  order  to  use  this  form  of  stimulation  successfully  one 
must  possess  an  extensive  knowledge  of  the  connections  of 
the  gland  with  the  nervous  system,  also  a  knowledge  of  the 
blood  vessels  of  the  gland. 

Effect  on  Heart  Beat — Any  manipulation  which  does 
not  affect  the  heart  beat  and  hence  the  initial  force  of  the 
blood  current  will  not  have  a  lasting  effect  in  a  local  area. 
All  manipulations  which  aim  to  affect  the  circulation  of  a 
gland  must  be  intense  and  prolonged  sufficiently  to  bring 
about  a  general  readjustment  of  the  circulation.  The  force 
of  the  heart  beat  and  the  resistance  of  the  arterioles  must  both 
be  affected.  Such  an  effect  will  tend  toward  permanency. 

The  circulation  of  definite  areas  is  governed  within 
fairly  well  marked  areas  of  the  spinal  cord  and  we  can  effect^ 
these  areas  by  indirect  manipulations,  but  it  would  not  be 
conducive  to  the  benefit  of  the  whole  body  if  one  portion  of 
it  could  be  permanently  excited  or  depressed  by  any  thera- 
peutic means  whatsoever ;  co-operation  of  all  portions  is  neces- 
sary to  maintain  the  activity  of  any  one  portion.  This  fact 
proves  that  our  therapeutics  must  be  far-reaching  in  their 
effects.  Therefore  to  increase  the  activity  of  a  gland  we  must 
affect  not  only  the  tension  of  the  blood  vessels  by  means  of 
vaso-motor  nerves  but  also  the  force  of  the  blood  stream,  the 
vis  a  tergo  given  it  by  the  heart.  True  it  is  that  the  tension 
quickly  reacts  on  the  heart  but  clinical  practice  demonstrates 
that  a  longer  effect  is  secured  if  both  factors  in  the  circulation  y 
are  directly  affected  by  manipulation. 

Classes  of  Stimuli. — Since  secretory  tissues  are  under 
the  control  of  secretory  and  vaso-motor  nerves,  and  these 
nerves  respond  to  at  least  five  forms  of  stimuli,  our  thera- 
peutic procedures  may  comprehend  one  or  all  of  these  forms 
of  stimuli.  The  five  forms  are,  mechanical,  thermal,  chemical, 


112  PKIXCIPLES  OF  OSTEOPATHY. 

electrical   and   psychical.     The   osteopath    uses   all   of  these. 
Mechanical  and  thermal  are  the  principle  forms. 

Manipulation  being-  the  special  therapeutic  means  used 
by  the  osteopath,  we  do  not  desire  to  take  your  time  and  at- 
tention in  a  discussion  of  the  other  means  of  affecting  secre- 
tory activity  which  are  discussed  at  length  in  many  useful 
volumes. 

Perspiration. — The  secretion  of  the  skin,  perspiration, 
is  a  profound  regulating  factor  in  the  health  of  every  indi- 
vidual. Its  normal  activity  must  be  maintained  at  all  times. 
We  are  called  upon  frequently  to  either  increase  or  check  it. 
The  treatment  of  fever  is  largely  comprehended  in  the  in- 
crease of  this  secretion  for  purposes  of  heat  elimination. 
When  we  succeed  in  affecting  the  respiratory  glands  so  that 
they  will  accept  the  material  brought  to  them  by  the  cutaneous 
blood  vessels  we  have  in  large  measure  solved  the  problem 
of  secretion  in  the  kidneys.  Any  therapeutic  procedure  which 
favorably  affects  the  blood  tension  in  the  skin  also  affects 
the  tension  in  the  kidneys,  hence  our  treatment  is  not  ad- 
dressed primarily  to  either  system  of  secretory  cells  but  to 
the  readjustment  of  speed  and  tension  of  the  blood  stream 
throughout  the  body.  The  cardiac  centers  and  large  vaso- 
motor  centers  are  the  points  which  we  desire  to  affect,  de- 
pending on  the  readjustment  of  tension  in  the  peripheral 
blood  vessels  to  secure  the  desired  results. 

Clinical  experience  seems  to  demonstrate  that  perspira-\ 
tion  can  best  be  established  by  manipulation  in  the  interscapu- 
lar  area,  i.  e.,  between  the  first  and  seventh  dorsal  vertebrae.     I 
A  relaxation  of  the  muscles  in  that  area  will  frequently  be    / 
followed  by  gentle  perspiration  over  the  entire  body.     This 
result  is  probably  brought  about  by  the  inhibitory  effect  of    I 
the  manipulation  around  the   first   dorsal  spine,   the  cardiac 
accelerator  center.     It  is  also  probably  due  to  the  fact  that 
the  vaso-constrictor  fibers  to  the  blood  vessels  of  the  head, 
neck,  upper  portion  of  the  trunk  and  upper  extremities  pass 
out  of  the  spinal  cord  between  the  second  and  seventh  dorsal 
vertebrae.     We  have  never  seen  a  case  of  fever  in  which  this 
manipulation  was  not  at  least  partially  beneficial.     Its  effects 


PRINCIPLES  OF  OSTEOPATHY.  113 

are  far-reaching.  The  average  case  of  la  grippe  will  yield  to 
this  treatment  almost  immediately  if  the  treatment  is  given 
on  the  day  of  the  attack. 

It  is  well  known  that  fear,  intense  mental  or  physical 
pain  will  cause  profuse  perspiration  and  pallor  of  the  skin. 
At  rare  intervals  a  case  is  seen  where  perspiration  is  intense 
during  the  sleeping  hours  and  no  mental  or  physical  pain  is 
experienced,  nor  is  there  any  tuberculous  infection.  In  all 
these  cases  the  perspiration  is  a  reflex  condition  and  hence 
our  manipulation  must  be  addressed  to  the  causative  factor. 
Perspiration  caused  by  pain  is  the  most  easily  relieved  by  in- 
hibition of  the  pain.  Heat  may  take  the  place  of  inhibition. 

Secretion  in  the   Digestive  Tract. — Too  much  or  too\ 
scanty  secretion  in  the  digestive  tract  is  the  most  common      , 
condition  we  have  to  deal  with.     Excessive  intestinal  secre- 
tion, as  in  diarrhoea,  is  in  all  probability  more  quickly  and 
successfully  treated  by  manipulation  than  by  any  other  means.     / 
In  this  condition  the  secretory  cells  seem  to  be  directly  under    I 
the  control  of  the  spinal  centers  and  respond  almost  imme- 
diately to  inhibitory  pressure  over  these  centers. 

In  the  treatment  of  lack  of  intestinal  secretion  many  fac-    / 
tors  must  be  considered.     The  average  case  which  comes  to  i 
us  with  this  complaint  has  been  drugged  to  such  a  point  that  \ 
the  integrity  of  the   secretory  apparatus    is  affected.     Over    \ 
stimulation  by  chemical  means  has  resulted  in  atrophy  of  se- 
cretory cells. 

We  must  bear  in  mind  that  a  large  proportion  of  the  so- 
called  diseases  we  are  called  upon  to  treat  are  drug  diseases. 
Structure  has  many  times  been  ruined  by  the  use  of  drugs.    / 
hence  we  fail  because  the  mechanism  is  destroyed. 

Pulmonary  Respiration. — One  more  point  in  regard  to 
secretion,  i.  e.,  the  selective  power  of  cells  requires  our  earnest 
thought  and  attention.  Respiration  is  a  secretory  process. 
Therefore  our  treatment  must  comprehend  the  same  princi- 
ples as  have  been  noted  in  relation  to  other  secretory  tissues. 

Importance  of  the  Cell. — The  all  importance  of  the 
cell  and  its  harmonious  working  with  its  fellows  seems  to  us 
to  lend  a  new  dignity  and  power  to  the  position  ;iow  being 


114  PRINCIPLES  OF  OSTEOPATHY. 

won  by  osteopathy.  The  treatment  of  disease  according  to 
the  light  of  physiological  knowledge  is  the  system  of  thera- 
peutics which  will  win  the  confidence  of  the  world.  Os- 
teopathy is  winning  that  confidence. 


CHAPTER  VI. 


THE  SYMPATHETIC  NERVOUS  SYSTEM. 

Unity  of  the  Nervous  System.— It  gives  a  wrong  imA 
pression  to  speak  of  the  CEREBRO-SPINAL  NERVOUS 
SYSTEM  and  the  SYMPATHETIC  NERVOUS  SYSTEM, 
as  though  they  are  independent  of  each  other.  They  are  parts 
of  a  single  system.  They  make  all  parts  of  the  body  inter- 
communicative,  and  make  it  possible  for  a  slight  stimulus  to 
cause  a  widespread  response.  They  convey  all  impulses  of 
a  sensory  character  to  the  central  nerve  cells  and  cause  inter- 
nal activity  and  response  to  external  stimuli.  In  fact,  the 
harmonious  action  of  the  tissues  in  our  body  depends  on  every 
cell  knowing  the  condition  of  every  other  cell.  Each  cell  is 
capable  of  perfect  life  only  so  long  as  it  is  able  to  communi- 
cate with  the  central  nervous  system,  ready  to  give  and  to 
receive,  thus  fulfilling  the  law  of  reciprocity. 

For  convenience  of  description,  the  nervous  system  is 
divided  into  the  cerebro-spinal  and  the  sympathetic.  We  have 
already  said  that  these  are  parts  of  one  whole.  They  are  con- 
tinuous anatomically  and  physiologically.  In  the  attempt  to 
write  of  them  separately,  we  desire  you  to  bear  constantly  in 
mind  their  interdependence. 

"The  dependence  and  independence  of  the  cerebro-spinal 
and  sympathetic  system  of  nerves  may  be  compared  to  the 
State  and  Federal  Governments,  or  the  Municipal  and  State 
Governments.  The  former  run  in  harmonv,  when  friction 


PEIXCIPLES   OF  OSTEOPATHY.  115 

does  not  arise,  yet  the  State  lives  quite  a  distinct,  individual 
life — quite  independent  of  the  Federal  Government.  And  the 
life  of  each  is  dependent,  however,  on  the  other.  The  inter- 
nal life  of  each  (as  of  the  sympathetic)  maintains  itself." — 
Byron  Robinson  in  the  "Abdominal  Brain,"  page  55. 

Origin. — The   sympathetic   appears   to   originate    from 
the  ganglia  on  the  posterior  roots  of  the  spinal  nerves. 

(1)  Lateral   Ganglia. — The   substance   of   the   sympa- 
thetic  is  conveniently  divided  into   four  portions :     ( I )    The 
lateral  chains  of  ganglia,  placed  one  on  each  side  of  the  ver- 
tebral column.     The  chains  are  connected  above  by  the  Gang- 
lion of  Ribes   (French,   1800-1864),  situated  on  the  anterior 
communicating  artery,  and  joined  below  by  the  Ganglion  Im- 
par  situated  on  the  anterior  surface  of  the  coccyx.      These 
chains  of  ganglia  are  connected  with  the  cerebro-spinal  nerves 
by  well  marked  cords. 

(2)  Four  Prevertebral  Plexuses. — The  next  prominent 
aggregations  of  nerve  tissue  are  the  great  prevertebral  plexuses  \ 
situated  ventral  to  the  bodies  of  the  vertebrae.     The  FIRST,  \  Q 
or  Pharyngeal,  is  situated  around  the  larynx.     The  SECOND,  /  \ 
or  Cardio-Pulmonary  Plexus,  lies  in  the  thorax.    The  THIRD,  / 

or  Solar  Plexus,  encircles  the  Coeliac  Axis  and  superior  mes-/ 
enteric  artery.  The  FOURTH  is  the  Pelvic  Plexus,  which 
governs  the  generative  organs  and  rectum. 

(3)  Visceral  Uanglia. — The  third  part  of  the  sympa-v 
thetic  tissue  is  composed  of  those  ganglia  placed  between  the 
coats  of  viscera,  and  called  the  peripheral  apparatus  or  "Aus 
tomatic  Visceral  Ganglia."     (Robinson.) 

(4)  Communicating  Fibers. — All  of  these  ganglia  and 
plexuses  are  intimately  connected  with  each  other  by  numer-  \ 
ous  nerve  fibres.     These  four  parts  constitute  what  is  com-  \ 
monly  known   as   the   SYMPATHETIC   NERVOUS    SYS-    W 
TEM.     The  nerve  fibres  in  the  sympathetic  system  consist  of    / 
both  the  medullated  and  non-medullated  varieties,  i.  e.,  white  / 
and  gray.     It  is  commonly  believed  that  the  white  are  cerebro-/ 
spinal  and  the  gray  are  sympathetic  fibres,  though  whether 
they  belong  to  the  one  or  other  system  cannot  be  told  by  ap- 
pearance  alone.     Function    must    also    be    considered.     The 


n6 


PRINCIPLES  OF   OSTEOPATHY. 


fibres  in  the  sympathetic  system  are  principally  of  the  non- 
medullated  variety;  hence,  gray  fibres  are  called  sympathetic. 

White  Rami-communicantes. —  The  chains  of  the  lat- 
eral ganglia  are  connected  with  the  spinal  nerves  serially  by 
two  distinct  nerve  bundles  to  each  ganglion.  These  bundles 
are  called  rami-communicantes,  and  are  composed  of:  (i) 
A  bundle  of  white  or  cerebro-spinal  fibres  passing  from  the 
anterior  and  posterior  roots  of  the  spinal  nerves  to  the 
ganglion,  in  which  a  few  fibres  may  end;  but  the  majority 
pass  on  to  be  distributed  to  the  prevertebral  plexuses,  there- 
by giving  direct  communication  between  viscera  and  the  spinal 
cord.  These  white  fibres  consist  of  both  motor  and  sensory 
fibres.  THE  WHITE  RAMI-COMMUNICANTES  LEAVE 
THE  SPINAL  CORD  BETWEEN  THE  SECOND  DOR- 
SAL AND  SECOND  LUMBAR  VERTEBRAE  ONLY. 
Many  of  the  fibres  are  de-medullated  in  the  lateral  ganglia; 
others  retain  their  sheaths  as  far  as  the  prevertebral  plexuses, 
where  they  also  become  de-medullated.  The  cervical  regio: 
has  no  white  rami-communicantes. 

Distribution. — The  nerves  in  the  sacral  region  which 
correspond  to  white  rami-communicantes,  pass  to  the  viscera 
without  entering  the  sympathetic  ganglia.  We  may  sum- 
marize what  we  have  written  concerning  the  ending  of  the 
white  rami-communicantes  as  follows:  (i)  End  in  the  lat- 
eral ganglia.  (2)  Pass  through  lateral  ganglia  and  end  in 
prevertebral  plexuses.  (3)  Split  up  before  entering  lateral 
ganglia  and  send  some  fibres  to  the  ganglia,  others  to  ganglia 
above  and  below,  after  passing  into  its  own  ganglia. 

Function. — The  white  rami-communicantes  have  many\ 
functions,  and  these  can  be  determined  by  a  close  study 
of  distribution  and  physiological  action.  The  functions  may 
be  tabulated  approximately  as  follows :  First,  it  has  been 
demonstrated  that  vaso-constrictors  pass  out  of  the  cord  be- 
tween the  second  dorsal  and  second  lumbar  vertebrae ;  second, 
cardiac  augmentors,  ending  in  the  lower  cervical  ganglia  and 
first  thoracic  ganglion ;  third,  motor  fibres  to  the  plain  mus- 
cles of  the  intestines ;  fourth,  motor  fibres  to  the  sphincter 
of  the  iris  leave  the  cord  at  the  third  dorsal  and  ascend  m  the 


PKINCIPLES   OF  OSTEOPATHY.  117 

chaia-.of   sympathetic   ganglia ;   fifth,   inhibitory  fibres   to  the  i 
viscera;  sixth,  sensory  fibres  from  viscera. 

In  other  words,  it  may  be  tabulated  as  follows :  The  ab- 
dominal splanchnics  contain  viscero-motor  and  viscero-in- 
hibitory,  vaso-constrictor,  vaso-dilator  and  sensory  fibres, 
which  are  white  rami-communicantes.  Since  no  white  rami- 
communicantes  leave  the  cord  above  the  second  dorsal  or  be- 
low the  second  lumbar,  the  cardiac  augmentors  and  the  con- 
strictors to  the  spincters  of  the  iris  probably  leave  the  cord 
as  white  rami-communicantes  in  the  dorsal  region. 

We  have  thus  far  considered  only  those  fibres  which  are 
supposed  to  originate  in  the  cerebro-spinal  system ;  at  least, 
they  are  medullated  nerves,  and  hence  are  considered  cerebro- 
spinal  in  character. 

As  we  have  previously  stated,  the  bond  of  union  be- 
tween the  sympathetic  and  cerebro-spinal  systems  consists  of 
a  white  and  gray  bundle. 

Gray  Rami-communicantes. — These  gray  fibres  are  non- 
medullated  and  originate  in  the  lateral  ganglia,  being  axis 
cylinder  processes  of  nerve  cells  in  those  ganglia,  passing 
thence  to  the  spinal  nerves  and  spinal  cord. 

Distribution. — They  pass  first  to  the  anterior,  primary 
divisions  of  the  spinal  nerves  and  continue  with  them  to  their 
distributive  area ;  or  they  may  pass  to  the  distribution  area  of 
the  posterior  division,  to  the  distribution  area  of  the  recur- 
rent branch  of  the  spinal  nerve,  and  to  the  structures  (dura) 
surrounding  the  posterior  root  of  the  spinal  nerve  and  to  the 
spinal  cord. 

Function. — Since  the  function  of  the  sympathetic  sys- 
tem is  to  control  the  calibre  of  blood  vessels,  the  plain  muscle 
fibres,  and  the  action  of  the  secretory  and  excretory  glands, 
we  may  state  the  function  of  these  gray  rami-communicantes 
to  be  as  follows  :  ( i )  Vaso-niotor  to  the  Mood  vessels  of  the 
skin  and  skeletal  muscles  in  the  area  of  distribution  of  spinal 
nerves ;  also  secretory  to  the  s\veat_gjands,  and  motor  to  the 
plain  muscle  controlling  the  hairs;  (2)  vaso-motor  to  the 
blood_j££ssels  in  the  spinal  cord  and  its  membranes.  The 
nerves  passing  from  the  lateral  ganglia  to  the  prevertebral 


Il8  PEINCIPLES  OF   OSTEOPATHY. 

plexuses,  therefore,  contain  white  and  gray  fibres  having  the 
functions  o'f  the  sympathetic  and  cerebro-spinal  systems,  and 
from  these  prevertebral  plexuses,  fibres  pass  to  the  distal 
ganglia  in  the  walls  of  the  viscera.  Thus  we  see  that  all  the 
ganglia  of  the  sympathetic  are  closely  connected  with  the 
cerebro-spinal.  These  ganglia  demedullate  the  spinal  nerves 
which  enter  them,  and  more  fibres  leave  the  ganglia  than  en- 
ter them.  These  ganglia  have  a  trophic  influence  over  the 
nerves  which  originate  in  them,  and  which  pass  from  them 
to  the  periphery.  They__are  reflex  ceatecsr- 

Functions  of  the  Sympathetic  System. — "In  general  it  ] 
may  be  said  that  the  sympathetic  presides  over  involuntary  / 
movements,  nutrition  and  secretion,  holds  an  important  in- 
fluence over  temperature  and  vaso7inotor  action,  and  is  en-  \ 
dowed  with  a  dull  sensibility."  (Robinson's  "Abdominal  J 
Brain.") 

Independent  or  Dependent. — Whether  the  action  of 
the  sympathetic  is  independent  or  dependent  is  no  longer 
subject  for  experiment  and  discussion.  You  have  seen  the 
heart  beat  after  extirpation  from  the  body;  also  the  ver- 
micular motion  of  the  intestines.  These  are  offered  as  evi- 
dences of  independent  action ;  but  itmust_be  borne_jn— mind 
that  under  normal  conditions  the  cerebro-spinal  nerves  can 
influence  these  activities,  either  repressing  or  augmenting 
them. 

Ganglia. — The  ganglia  of  the  sympathetic  contain  (a) 
nerve  cells,  (b)  afferent  fibres,  (c)  efferent  fibres — and  are 
therefore  governing  centers.  They  are  able  to  receive  sensa- 
tion, and  transform  this  into  motor  impulses,  and  hence  are, 
in  a  measure,  independent. 

Cervical  Ganglia  of  Importance  to  Osteopaths. — The 
cervical  portion  of  the  gangliated  cord  contains  three  ganglia 
which  are  designated  as  superior,  middle  and  inferior,  ac- 
cording to  position.  These  ganglia  are  important  to  the  os- 
teopath, because  they  are  in  a  measure  affected  by  direct 
manipulation,  i.  e.,  pressure  can  be  transmitted  to  them  through 
the  soft  tissues  over  them. 

Superior  Cervical  Ganglion. — The     superior     cervical 


PKIXCIPLES   OF  OSTEOPATHY.  119 

.ganglion  lies  on  the  rectus  capitis  anticus  major  muscle  and 
sends  branches  upward  which  form  a  plexus  around  the  in- 
ternal carotid  artery  (carotid  plexus).  The  cavernous  plexus 
is  a  continuation  of  this.  From  these  plexuses  many  com- 
municating branches  pass  to  unite  with  the  cranial  nerves  of 
the  cerebro-spinal  system. 

Connections. — This  ganglion  is  connected  with  the 
first  four  spinal  nerves,  and  the  ninth,  tenth  and  twelfth 
cranial.  Its  branches  are  distributed  on  all  the  blood  vessels 
of  the  head  and  face. 

Vaso-constriction. — Physiological  experiment  has  de- 
monstrated that  this  ganglion  exercises  a  vaso-constrictor  in- 
fluence over  the  blood  vessels  of  the  head  and  face. 

Distribution. — "The  terminal  filaments  from  the  caro- 
tid and  cavernous  plexuses  are  prolonged  along  the  internal  ca- 
rotid artery,  forming  plexuses  which  entwine  around  the  cere- 
bral and  ophthalmic  arteries  ;  along  the  former  vessels  they  may 
be  traced  into  the  pia  mater;  along  the  latter,  into  the  orbit, 
where  they  accompany  each  of  the  subdivisions  of  the  vessel, 
a  separate  plexus  passing  with  the  arteria  centralis  retinae, 
into  the  interior  of  the  eye-ball.  The  filaments  prolonged  onto 
the  anterior  communicating  artery  form  a  small  ganglion,  the 
Ganglion  of  Ribes,  which  serves,  as  mentioned  above,  to  con- 
nect the  sympathetic  nerve  of  the  right  and  left  side."  (Gray's 
Anatomy,  page  871.) 

Reasoning  from  the  position  of  the  ganglion,  in  the  neck, 
its  distribution  to  blood  vessels  of  the  head  and  face,  and  its 
vaso-constrictor  functions  to  the  vessels,  we  can  readily  un- 
derstand why  mechanical  lesions  in  the  upper  cervical  region 
can  be  the  cause  of  grave  pathological  conditions  in  the  tissues 
of  the  head  and  face.  Anything  which  disturbs  the  normal 
circulation  in  a  definite  area  will  necessarily  affect  the  nu- 
trition of  the  tissues  in  that  area ;  therefore,  nutritional  dis- 
orders of  the  eye  are  found  to  be  caused  by  subluxation  of 
vertebrae,  or  contraction  of  muscles  in  relation  to  the  superior 
cervical  ganglion. 

Headache. —  Since  sympathetic  branches  are  distributed 
to  the  blood  vessels  of  the  pia  mater,  we  may  reasonably 


120  PKINCIPLES  OF  OSTEOPATHY. 

expect  to  affect  the  calibre  of  these  vessels  in  the  case  of 
congestive  headache,  by  removing  all  obstructions, — e.  g., 
contracted  muscles  causing  dilatation, — to  the  active  func- 
tioning of  the  superior  cervical  ganglion.  The  distribution 
of  these  sympathetic  nerves  to  the  orbit,  nose,  pharynx,  ton- 
sils, palate,  and  sinuses,  explains  the  possibility — yes,  proba- 
bility— of  a  mechanical  lesion  in  the  upper  cervical  region  in 
these  cases. 

Middle  Cervical  Ganglion. — The  middle  cervical  gan- 
glion is  the  smallest  of  the  three.  "It  is  placed  opposite  the 
sixth  cervical  vertebra,  usually  upon  or  close  to  the  superior 
thyroid  artery;  hence  the  name  of  'Thyroid  Ganglion'  as- 
signed to  it  by  Haller."  It  sends  branches  to  the  fifth  and 
sixth  spinal  nerves. 

Distribution. — It  sends  branches  to  accompany  the 
inferior  thyroid  artery  to  the  thyroid  gland,  where  they  com- 
municate with  the  superior  and  recurrent  laryngeal  nerves. 
These  branches  regulate  the  calibre  of  the  inferior  thyroid 
artery  and  its  branches.  The  chief  nerve  trunk  passing  from 
this  ganglion  is  the  middle  cardiac  nerve.  The  cardiac  aug- 
mentors  leave  the  spinal  cord  as  white  rami-communicantes 
to  the  second,  third  and  fourth  dorsal  ganglia,  then  pass  up- 
ward to  the  middle  cervical  ganglion.  This  ganglion  is  con- 
nected with  the  superior  cervical  ganglion. 

Function. — The  functions  of  this  ganglion  'are  (a) 
vaso-constrictor  (through  connection  with  the  superior 
cervical  ganglion)  to  the  blood  vessels  of  the  head  and  face ; 
(b)  vaso-constrictor  to  the  vessels  of  the  thyroid  gland;  (c) 
augmentor  influence  to  the  heart. 

Manipulation. — Therefore,  inhibition  (pressure)  will 
lessen  those  influences,  and  stimulation  (make-and-break 
pressure)  will  increase  them.  Since  sympathetic  centers 
(ganglia)  control  vaso-motion  and  secretion,  we  may  consider 
that  this  ganglion  controls  vaso-motion  and  perspiration  in 
the  area  of  distribution  of  the  fifth  and  sixth  cervical  spinal 
nerves. 

Inferior  Cervical  Ganglion. — "The  inferior  cervical 
ganglion  is  situated  between  the  base  of  the  transverse  pro- 


PKIXCIPLES   OF  OSTEOPATHY.  121 

cess  of  the  last  cervical  vertebra  and  the  neck  of  the  first 
rib,  on  the  inner  side  of  the  superior  intercostal  artery." 

Distribution. — It  connects  with  the  ganglion  above, 
and  the  fibres  which  connect  it  with  the  first  thoracic  ganglion 
pass  both  in  front  of  and  behind  the  subclavian  artery.  Its 
chief  branch  is  the  inferior  cardiac  nerve,  which  communi- 
cates with  the  middle  cardiac  nerve  and  the  recurrent  laryn- 
geal  nerve.  It  sends  gray  rami-communicantes  to  the  seventh 
and  eighth  cervical  nerves ;  also  some  branches  which  pass  up- 
ward to  the  vertebral  artery.  The  fibres  which  encircle  the 
subclavian  artery  are  called  the  Annulus  of  Vieussens,  and 
some  fibres  to  the  cardiac  nerve  are  given  off  from  it. 

Function. — From  this  distribution  we  may  draw  the 
following  conclusions  as  to  the  function  of  the  inferior  cervical 
ganglion;  (a)  It  is  vaso-motor  to  the  area  of  distribution  of 
the  seventh  and  eighth  cervical  nerves;  (b)  it  controls  per- 
spiration in  this  same  area;  (c)  it  is  vaso-motor  to  the  ver- 
tebral artery  and  its  branches  in  the  posterior  fossa  of  the 
skull;  (d)  vaso-motor  to  the  internal  mammary,  inferior  thy- 
roid, and  nervi  comes  phrenici  arteries;  (e)  augmentor  in- 
fluences to  the  heart. 

Manipulation. — Treatment  on  this  ganglion  would  les- 
sen its  vaso-constrictor  influence  over  the  arteries  named, 
and  they  would  then  carry  more  blood  at  a  slower  rate.  The 
stimulation  of  this  ganglion  would  raise  blood  pressure  in 
the  area  it  controls,  and  augment  the  force  of  the  heart. 

Recapitulation. — It  has  been  mentioned  that  the  cervi- 
cal ganglia  receive  no  white  rami-communicantes  from  the 
cervical  nerves,  and  that  vaso-constrictor  fibres  pass  from 
cerebro-spinal  to  the  sympathetic  system  in  the  white  rami- 
communicantes  between  second  dorsal  and  second  lumbar 
vertebrae ;  therefore,  the  constrictor  influence  manifested  by 
the  cervical  sympathetics  is  derived  from  the  second,  third 
and  fourth  dorsal.  They  derive  fibres  also  from  the  upper 
thoracic  region,  as  follows :  (a)  augmentor  fibres  to  the 
heart  from  the  second,  third  and  fourth  dorsal ;  (b)  secretory 
fibres  to  the  salivary  glands,  second  and  third  dorsal;  (c) 
pupilo-dilator  and  motor  fibres  to  the  involuntary  muscles  of 


122  PKINCIPLES  OF  OSTEOPATHY. 

the  eye  and  orbit  from  second  and  third  dorsal;  (d}  afferent  ] 
fibres  whose  stimulation  causes  activity  of  the  vase-motor/* 
center  in  the  medulla. 

Thoracic  Ganglia. — "The  thoracic  portion  of  the  gan- 
gliated  cord  consists  of  a  series  of  ganglia  which  usually 
correspond  in  number  to  that  of  the  vertebrae,  but  from  the 
occasional  coalescence  of  two,  their  number  is  uncertain. 
These  ganglia  are  placed  on  each  side  of  the  spine,  resting 
against  the  head  of  the  rib  and  covered  by  the  pleura  cos- 
talis ;  the  last  two  are,  however,  anterior  to  the  rest,  being 
placed  on  the  sides  of  the  bodies  of  the  eleventh  and  twelfth 
dorsal  vertebrae.  The  ganglia  are  small  in  size,  and  of  a 
gray  color.  The  first,  larger  than  the  rest,  is  of  an  elongated 
form,  and  frequently  blended  with  the  last  cervical.  They  are 
connected  together  by  cord-like  prolongations  of  their  sub- 
stance. In  the  thoracic  region  the  ganglia  are  connected  with 
the  spinal  nerves  by  both  white  and  gray  rami-communi- 
cantes." — (Gray's  Anatomy,  Page  804  in  1901  Edition.) 

Rami-efferentes. — The  rami-efferentes  or  .branches  of 
distribution,  are  divided  into  an  internal  and  external  set. 
The  external  branches  are  smaller,  being  distributed  to  the 
bodies  of  the  vertebrae  and  their  ligaments.  The  internal 
branches  may  properly  be  divided  into  an  upper  and  lower 
group,  which  are  distributed  to  the  viscera  of  the  thorax  and 
abdomen. 

Upper  Five  Thoracic  Ganglia. — The  upper  five  thoracic 
ganglia  send  branches  which  are  distributed  around  the  upper 
portion  of  the  descending  aorta.  From  the  second,  third  and 
fourth  ganglia  are  given  branches  to  the  posterior  pulmonary 
plexus,  which  control  the  tissues  of  the  lungs.  You  will  re- 
member that  the  pneumogastric  nerves  are  the  motor,  sensory 
and  trophic  nerves  to  the  air  passages.  The  sympathetic, 
second  to  seventh  dorsal,  are  vaso-motor  and  trophic  to  the 
blood  vessels  of  the  tissues  of  the  lungs.  We  have  now  laid  a 
foundation  of  anatomical  and  physiological  facts  upon  which 
we  may  base  our  principles  of  treatment.  The  upper  thoracic 
region  is  an  important  one,  because  in  it  we  find  not  only  those 
white  rami-communicantes  which  are  distributed  to  the  aorta 


PRINCIPLES   OF  OSTEOPATHY.  123 

and  lungs,  joining  with  the  pneumogastric  nerve  to  complete 
the  plexuses  which  control  lung  action,  but  also  those  white 
rami-communicantes  which  ascend  to  the  cervical  ganglia,  and 
are  distributed  as  follows : 

Nerve  Distribution. — "(x)  Pupilo-dilator  fibres  pass 
by  rami-communicantes  from  the  first,  second  and  third  tho- 
racic nerves,  ascend  in  the  sympathetic  cord  to  the  superior 
cervical  ganglion  to  form  arborizations  around  the  cells. 
These  gray  fibres  pass  to  the  Gasserian  Ganglion  and  reach 
the  eye  ball  by  the  ophthalmic  division  of  the  fifth  and  long 
ciliary  nerves;  (2)  motor  fibres  to  the  involuntary  muscles  to 
the  orbit  and  eyelids,  from  the  fourth  and  fifth  thoracic  nerves, 
following  a  similar  course;  (3)  vaso-motor  fibres  to  the  head, 
secretory  fibres  to  the  submaxillary  glands,  and  pilo-motor 
fibres  to  the  head  and  neck,  are  derived  from  the  upper  tho- 
racic nerve,  and  reach  their  area  of  distribution,  after  similar 
interruption,  in  the  superior  cervical  ganglion;  (4)  the  ac- 
celerator fibres  to  the  heart  are  derived  from  the  upper  tho- 
racic nerves,  and  end  similarly  in  the  middle  and  lower 
cervical  ganglia,  gray  fibres  in  the  cervical  cardiac  nerve  com- 
pleting the  connection." — (Gerrish's  Anatomy,  Page  18.) 

Interscapular  Region. — Therefore,  we  have  an  area 
extending  from  the  second  to  the  seventh  dorsal,  in  which 
we  must  make  careful  examination  for  lesions  affecting  vaso- 
motor,  trophic  and  secretory  activity  in  the  thoracic  viscera, 
upper  extremities,  and  structures  of  the  head,  face  and  neck. 
This  explains  to  you  why  a  treatment  in  the  interscapular 
region  has  such  far-reaching  effects. 

A  Case  Illustrating  the  Cilio-spinal  Center. — As  an  il- 
lustration of  the  nerve  connection  between  the  cilio-spinal 
center,  first,  second  and  third  dorsal  and  the  eye,  I  wish  to 
call  your  attention  to  a  patient  who  was  in  the  clinic  of  the 
P.  S.  O.  two  years  before  the  time  I  write.  There  was 
extensive  inflammation  of  the  conjunctiva  of  the  right  eye, 
sight  in  that  eye  was  almost  gone  on  account  of  the  opacity 
caused  by  the  inflammation  of  the  conjunctiva  over  the  cornea. 
This  condition  was  present  for  five  years.  The  inflammation 
had  traveled  to  the  nasal  duct,  and  as  a  result  it  was  closed.  The 
duct  had  been  opened  by  the  surgeon's  knife  long  before  we 


124  PKINCIPLES  OF  OSTEOPATHY. 

saw  the  case.  A  close  examination  of  the  center  likely  to 
be  irritated  in  such  a  condition  disclosed  the  fact  that  the  area 
between  the  first  and  third  dorsal  vertebrae  was  exceedingly 
sensitive,  and,  most  interesting  of  all,  pressure  on  this  area 
caused  intense  pain  in  the  inflamed  eye,  and  caused  the  pupil 
to  dilate.  The  muscles  in  the  interscapular  area  were  very 
much  contracted.  Treatment  was  given,  and  in  proportion 
to  the  amount  of  relaxation  gained  in  the  interscapular  area, 
the  -inflammation  in  the  conjunctiva  subsided.  After  one 
month's  treatment,  the  patient  could  see  to  thread  a  needle, 
using  only  the  formerly  diseased  eye.  Pressure  at  the  third 
dorsal  spine  still  causes  the  patient  to  speak  of  a  sense  of 
pressure  or  swelling  in  the  eye.  (Two  years  have  passed 
since  this  was  written.  The  patient  has  continued  to  have 
perfect  use  of  the  eye.) 

The  following  extract  from  "The  Osteopath"  in  regard 
to  this  case,  is  of  interest  to  us  while  considering  the  sympa- 
thetic nervous  system :  "It  is  not  surprising  that  diseases  of 
the  eye  should  affect  the  sympathetic  nerve,  and  that  by  that 
path  the  center  known  as  the  'cilio-spinal.'  But  by  what  sen- 
sory path  would  the  influence  of  pressure  be  carried  to  the 
eye?  We  know  of  none.  From  the  first  two  dorsal  nerves, 
which  are  identical  with  the  cilio-spinal  center,  sympathetic 
fibres  are  distributed  to  the  dilating  muscle  fibres  of  the  iris, 
and  when  stimulated  cause  dilatation  of  the  pupils.  From 
the  third  dorsal  nerve  fibres  are  distributed  which  regulate  the 
calibre  of  the  blood  vessels  of  the  eye.  Under  the  pressure, 
either  set  of  these  fibres  may  be  affected.  The  first  may  be 
stimulated,  dilating  the  muscles  of  the  iris  so  as  to  press  upon 
filaments  of  sensitive  nerves ;  or,  the  pressure  may  inhibit  the 
vaso-constrictor  function  of  the  other  nerve,  and  by  dilating 
the  arterioles  cause  pressure  upon  the  sensitive  nerve ;  or,  both 
causes  may  operate  and  thus  induce  the  pain.  The  abundant 
supply  of  sensory  nerves  to  the  ciliary  muscle,  iris  and  cornea, 
from  the  nasal  branch  of  the  ophthalmic  division  of  the  fifth 
nerve  and  the  short  ciliary  branches  from  the  ciliary  (lenticu- 
lar or  ophthalmic)  ganglion  makes  it  conceivable  that  any 
change  of  arterial  pressure  might  affect  these  nerves  to  the 


PKINCIPLES  OF  OSTEOPATHY.  125 

extent  of  causing  pain.  It  seems  reasonable  to  conclude  that 
there  was  no  inflammation,  but  congestion,  and  partial  paraly- 
sis of  the  vaso-constrictor  nerve." — (A.  E.  Brotherhood,  D. 
O.,  D.  Sc.  O.,  in  "The  Osteopath,"  Vol.  V.,  No.  III.) 

Effects  of  Treatment,  First  to  Seventh  Dorsal. — Treat- 
ment in  the  interscapular  region,  first  to  seventh  vertebrae, 
may  reasonably  be  expected  to  affect  the  heart  beat,  the  nu- 
tritional circulation  in  the  lungs,  and  the  circulation  in  the  up- 
per extremities,  head,  neck  and  face. 

The  remainder  of  the  dorsal  area  constitutes  what  is 
called  the  splanchnic  region.  Three  splanchnic  nerves  are 
given  off  from  this  region  to  be  distributed  to  the  prevertebral 
plexuses  in  the  abdominal  cavity. 

The  Great  Splanchnics. — The  first  is  called  the  Great 
Splanchnic  and  takes  origin  from  the  sixth  to  the  tenth  dorsal 
nerves,  and  probably  receives  many  filaments  from  the  upper 
dorsal  nerves.  It  is  a  large  nerve  trunk  and  contains  many 
medullated  nerves  from  the  cerebro-spinal  system.  Its  course 
is  downward  and  inward,  perforates  the  crus  of  the  dia- 
phragm and  ends  in  the  semilunar  ganglion.  Some  fibres 
end  in  the  renal  and  suprarenal  plexuses. 

Lesser  Splanchnic. — The  Lesser  Splanchnic  arises  from 
the  tenth  and  eleventh  ganglia  and  their  connecting  cord. 
It  also  takes  a  downward  and  inward  course,  piercing  the 
crus  of  the  diaphragm,  and  ends  in  the  Coeliac  Plexus.  It 
communicates  with  the  Great  Splanchnic,  and  sometimes  sends 
fibres  to  the  renal  plexus. 

Least  Splanchnic. — The  Least,  or  Renal  Splanchnic, 
arises  from  the  last  thoracic  ganglion  and  ends  in  the  renal 
plexus.  It  sometimes  communicates  with  the  lesser  splanch- 
nic. 

Functions. — First,  vaso-constriction ;  second,  viscero- 
inhibition.  I  mention  merely  those  functions  which  have  been 
well  demonstrated  by  physiological  experiments  and  osteo- 
pathic  practice. 

Theory. — The  osteopath  reasons  as  follows  concerning 
this  Splanchnic  area:  Since  the  Great  Splanchnic  ends  in 
the  semilunar  ganglion,  from  this  ganglion  and  plexuses 


126  PKIXCIPLES  OF   OSTEOPATHY. 

around  it  fibres  are  distributed  to  the  blood  vessels  of  the 
stomach,  liver,  spleen  and  intestines ;  therefore,  we  operate  in 
the  area  between  the  fifth  and  tenth  dorsal  spines  for  va so- 
motor  effects  on  the  above-mentioned  viscera.  Again,  the 
great  splanchnic  sends  viscero-inhibitory  fibres  to  the  mus- 
cular layers  of  the  stomach  and  intestines ;  hence,  we  con- 
trol excessive  muscular  activity  in  these  viscera  by  removing 
obstructions  to  the  normal  inhibitory  influence  of  these  nerves. 
The  Lesser  Splanchnic  has  the  same  functions,  but  exer- 
cises its  functions  chiefly  on  that  portion  of  the  intestinal 
muscular  layer  comprised  in  the  area  supplied  by  the  su- 
perior mesenteric  artery;  therefore,  the  tenth  and  eleventh 
dorsal  area  is  a  vaso-motor  and  motor-inhibitory  center  for  a 
segment  of  the  intestines.  The  renal  splanchnics  exert  a  vaso- 
constrictor influence  on  the  blood  vessels  of  the  kidneys,  and 
the  osteopath  secures  vaso-motor  effects  on  the  blood  vessels 
of  the  kidneys,  and  hence  affects  secretion  by  removing  ob- 
structions to  the  normal  influence  of  this  nerve. 

The  twelfth  dorsal  spine  marks  a  renal  center.  These 
nerves  contain  sensory  fibers  which  carry  sensation  from  the 
prevertebral  plexus  in  the  abdomen  to  the  spinal  cord.  There- 
fore, a  disturbance  in  the  viscera  can  reflex  its  painful  sen- 
sations to  the  area  of  greater  sensibility  which  is  in  close 
central  connection  with  the  seat  of  disturbance. 

It  should  be  borne  in  mind  that  the  power  of  movement 
resides  in  the  muscular  wall  of  the  intestine  and  is  initiated  by 
the  Automatic  Ganglia  in  its  walls,  which  are  excited  by  the 
pressure  of  food.  We  may  state  that  the  intestines  possess 
an  intrinsic  nerve  apparatus  which  initiates  peristalsis,  but 
the  control  of  the  movement  after  it  is  initiated  is  exercised 
by  cerebro-spinal  nerves.  The  pneumogastric  nerve  exercises 
a  decided  motor  influence  over  the  intestines.  And,  as  pre- 
viously stated,  the  great  and  lesser  splanchnics  are  inhibitory 
nerves  to  the  musculature  of  the  intestines. 

Lumbar  Ganglia. — Four  small  ganglia,  connected 
above  and  below  by  intercommunicating  fibres,  constitute  the 
lumbar  portion  of  the  sympathetic  ganglia.  These  ganglia 
are  connected  with  the  cerebro-spinal  lumbar  nerves  by  rami- 


PKINCIPLES  OF  OSTEOPATHY.  127 

communicantes.  The  first  and  second  ganglia  are  the  only 
ones  in  this  region  receiving  white  rami-communicantes.  The 
functions  which  we  found  were  exercised  in  the  lower  dorsal 
area  are  continued  into  the  lumbar  ganglia  as  far  as  the  sec- 
ond. These  ganglia  send  fibres  to  the  aortic  plexus,  the  hypo- 
gastric  plexus,  and  thence  to  the  pelvic  plexus.  They  also 
send  branches,  as  in  other  regions,  to  the  blood  vessels  sup- 
plying the  bones  and  ligaments  of  the  spinal  column. 

Since  vaso-constrictor  fibres  do  not  enter  the  sympathetic 
ganglia  below  the  second  lumbar,  we  may  reasonably  expect 
to  influence  the  circulation  of  the  lower  extremities  by  manipu- 
lations in  this  area. 

The  descending  colon  and  rectum  are  supplied  with 
viscero-inhibitory  fibres  from  this  area.  Vaso-constrictor 
fibres  are  supplied  to  the  blood  vessels  in  the  lower  portion 
of  the  abdomen.  The  influence  exerted  by  the  lumbar  sym- 
pathefics  may  be  tabulated  as  follows : 

ist:     Viscero-inhibitory  to  descending  colon  and  rectum. 

2nd :     Vaso-constrictor  to  lower  abdominal  blood  vessels. 

3rd:     Vaso-constrictor  to  the  blood  vessels  of  the  penis. 

4th :  Vaso-motor  fibres  to  the  blood  vessels  of  the  blad- 
der. 

5th :  Vaso-motor  fibres  to  the  blood  vessels  of  the 
uterus. 

6th :  Vaso-constrictor  to  the  blood  vessels  of  the  pelvic 
viscera. 

7th:  Motor  to  vas  deferens  (male),  round  ligament 
(female). 

8th :  Vaso-constrictor  to  the  blood  vessels  of  the  lower 
extremities. 

Sacral  Ganglia. — The  pelvic  portion  of  the  sympathetic 
chain  usually  consists  of  four  ganglia  situated  along  the  inner 
side  of  the  sacral  foramina,  and  communicates  with  the  four 
upper  sacral  nerves.  These  ganglia  are  connected  with  each 
other,  as  in  other  regions.  The  two  chains  connect  by  the 
Ganglion  Impar  on  the  anterior  surface  of  the  coccyx. 

Distribution. — The   rami-efferentes    are    distributed   to 


128  PKINCIPLES  OF  OSTEOPATHY. 

the  pelvic  plexus ;  or  a  plexus  on  the  middle  sacral  artery, 
and  to  vertebrae  and  ligaments  in  the  sacral  region. 

"Through  the  pelvic  plexus,  the  pelvic  viscera  are  sup- 
plied with  motor,  vaso-motor  and  secretory  fibres."  (Ger- 
rish's  Anatomy,  Page  648.) 

The  rami-communicantes  in  the  sacral  region  are  gray, 
hence,  the  influence  of  the  cerebro-spinal  system  is  carried 
down  from  the  upper  lumbar  ganglia. 

"Below  the  second  lumbar  vertebra  they  are  also  of  the 
gray  peripheral  variety."  ("Abdominal  Brain,"  Page  31.) 

In  the  sacral  region  the  spinal  nerves  are  distributed 
directly  to  the  pelvic  viscera;  some  fibres  pass  into  the  pelvic 
plexus,  thence  to  the  viscera. 

The  sacral  region  offers  an  area  in  which  the  osteopath 
can  secure  an  influence  on  pelvic  viscera  without  the  exten- 
sive sympathetic  connections  encountered  in  other  regions  of 
the  spine. 


Function. — These  sacral  nerves  are : 

ist:     Vaso-dilator  to  the  vessels  of  the  penis  and  vulva. 


"  /  9 •• 
2nd :     Motor  fibres  to  the  rectum. 

3rd:     Motor  fibres  to  the  bladder. 

4th :     Motor  fibres  to  the  uterus. 

Cardiac  Plexus. — The  three  great  prevertebral  plex- 
uses must  now  engage  our  attention.  The  first  one,  the  car- 
diac plexus,  is  situated  at  the  base  of  the  heart,  and  in  the  con- 
cavity of  the  arch  of  the  aorta;  this  portion  is  called  super- 
ficial, while  the  deep  portion  lies  between  the  trachea  and  the 
aorta. 

Position  and  Formation. — The  cardiac  plexus  is  formed 
by  fibres  from  the  pnuemogastric  and  cervical  cardiac  sym- 
pathetics.  "It  is  very  common  to  find  upper  cervical  cardiac 
branches  of  the  vagus  and  sympathetic  united  to  form  a  com- 
mon trunk.  In  other  cases,  the  nerves  branch  and  communi- 
cate with  each  other  in  a  plexiform  manner."  (Morris's 
Anatomy. ) 

The  cardiac  nerves  form  the  cervical  sympathetic  chain; 
all  enter  the  cardiac  plexus,  but  their  distribution  is  variable. 
The  superficial  plexus  receives  the  "left  superior  cardiac  nerve 


PRINCIPLES   OF   OSTEOPATHY.  129 

of  the  sympathetic  and  the  left  inferior  cervical  cardiac  branch 
of  the  pneumogastric." — (Morris's  Anatomy.) 

The  deep  cardiac  plexus  "receives  all  the  other  cardiac 
nerves."  From  the  superficial  cardiac  plexus  branches  pass 
to  the  plexus  around  the  right  coronary  artery  and  pass  to  the 
left  lung  to  join  the  anterior  pulmonary  plexus. 

From  the  deep  cardiac  plexus  branches  are  distributed 
to  the  anterior  pulmonary  plexus  of  both  sides,  the  left  coro- 
nary plexus,  right  auricle,  superficial  cardiac  plexus,  and 
right  coronary  plexus. 

Pulmonary  Plexus. — The\  anterior  pulmonary  plexus 
is  formed  by  a  branch  of  the  pneumogastric  and  the  sympa- 
thetic. It  is  situated  on  the  anterior  surface  of  the  bronchi 
and  the  branches  enter  the  lung  on  the  bronchus. 

The  posterior  pulmonary  plexus  is  formed  by  the  pneu- 
mogastric and  fibres  from  the  second,  third  and  fourth  tho- 
racic ganglia  of  the  sympathetic.  Its  branches  enter  the  lung 
on  the  posterior  aspect  of  the  bronchus. 

Physiology. — Physiological  experiments  have  demon- 
strated that  the  pneumogastric  is  motor  to  the  muscles  of  the 
bronchioles,  sensory  and  trophic,  while  the  sympathetics  are 
vaso-motor  and  trophic.  Therefore,  the  function  of  the  lungs 
and  heart  can  be  affected  by  operating  on  the  inter-scapular 
region. 

Functions. — The  functions  of  the  thoracic  plexus  are : 

ist:     Cardiac  augmentors,  per  sympathetics. 

2nd  :     Cardiac  inhibitor,  per  pneumogastric.  . 

3rd :  Vaso-constrictor  to  coronary  arteries,  per  pneumoA 
gastric. 

4th :  Vaso-constrictor  to  bronchial  arteries,  per  sympa-/ 
thetics,  first  to  fifth  dorsal. 

5th :  Sensory  fibres  to  the  pleura  and  lungs,  per  sym- 
pathetic, first  to  fifth  dorsal. 

6th :  Sensory  fibres  to  heart  and  pericardium,  per  sym- 
pathetic, second  to  fifth  dorsal. 

7th  :     Broncho-constrictor,  per  pneumogastric.  y 

8th  :     Broncho-dilator,  per  pneumogastric. 


130  PRINCIPLES  OF   OSTEOPATHY. 

9th :     Sensory  fibres  to  mucous  lining  of  air  passages,  per 
pneumogastric. 

Treatment. — A  true  inhibitory  treatment  would  pro- 
duce greatest  effect  on  the  heart,  if  administered  over  the 
middle  and  inferior  cervical  ganglia.  The  heart  would  be 
slowed.  Such  a  treatment  is  rarely  given,  because  nearly 
every  case  presents  some  physical  lesion,  which  if  removed, 
allows  normal  impulses  to  meet  in  the  cardiac  plexus  and  be 
re-organized  for  proper  distribution. 

Always  bear  in  mind  that  a  plexus  is  a  re-organizing 
center  for  nervous  impulses,  and  we  can  hope  only  to  regu- 
.late  the  function  of  an  organ  by  attempting  to  equalize  the 
impulses  reaching  its  controlling  plexus.  This  equalizing 
process  is  not  ordinarily  secured  by  the  administration  of 
inhibition  to  a  definite  nerve  trunk  which  ends  in  the  plexus, 
but  by  removing  a  lesion, — usually  bony  or  muscular — which 
is  affecting  the  nerve  fibre  in  the  direction  of  increase  or 
decrease  of  function. 

The  region  between  the  scapulae  is  in  close  central  con- 
nection with  the  lungs,  pleura,  heart  and  pericardium;  hence, 
painful  sensations  originating  in  these  organs  may  be  re- 
ferred to  this  area.  The  muscles  in  this  area  will  contract 
reflexly  from  irritation  of  these  organs,  or  from  exposure  of 
the  skin  over  them  to  a  change  of  temperature.  Hence,  in 
the  first  instance  the  contraction  is  a  secondary  lesion ;  in  the 
latter,  a  primary  one. 

Pressure  in  this  area  practically  causes  relaxation  of 
muscles,  removes  a  lesion;  but  the  patient  experiences  a  cessa- 
tion of  pain,  freer  respiration,  and  less  rapid  action  of  the 
heart. 

Results. — After  administering  inhibitory  pressure,  the 
osteopath  realizes  that  the  muscles  under  his-  fingers  are  softer 
than  formerly;  then  he  knows  that  he  has  actually  changed 
the  physiological  condition  of  an  important  tissue. 

Argument. — Coincident  with  the  softening  of  the  mus- 
cles, the  heart  beats  slower;  therefore,  he  has  removed  an 
irritant  to  the  augmentor  fibres  of  the  heart;  the  respiration 
is  deeper,  therefore,  a  change  has  been  secured  in  the  activity 


PBIXCIPLES  OF  OSTEOPATHY.  131 

of  the  walls  of  the  thorax,  and  in  the  circulation  of  blood  in 
the  bronchial  and  pulmonary  blood  vessels ;  the  pain  has  de- 
creased, therefore,  the  sensory  nerves  in  the  lung  tissue  are 
no  longer  irritated  by  hyperaemic  pressure  or  toxic  substances 
in  the  blood.  This  illustrates  to  you  why  the  osteopath  studies 
and  treats  the  interscapular  region  so  carefully. 

Solar  Plexus. — In  the  abdominal  cavity  we  find  the 
solar  plexus,  which  on  account  of  its  great  size  and  wonder- 
ful distribution,  Byron  Robinson  calls  the  "Abdominal 
Brain." 

Location  and  Formation. — It  is  placed  in  front  of  the 
aorta  at  its  entrance  into  the  abdomen,  and  surrounds  the  Coe- 
liac  Axis.  It  consists  of  two  semilunar  ganglia,  which  are  placed 
on  each  side  of  the  coeliac  axis,  and  are  connected  by  a  large 
number  of  fibres  which  pass  above  and  below  the  coeliac 
axis.  From  this  circle  of  ganglia  and  nerves,  fibres  are  given 
off  which  are  joined  by  branches  of  the  right  pneumogastric, 
and  by  both  small  splanchnics.  The  great  splanchnic  ends 
in  the  semilunar  ganglion. 

Distribution. — The  branches  of  distribution  from  the 
solar  plexus  are  prolonged  on  the  branches  of  the  abdominal 
aorta  as  subsidiary  plexuses,  taking  their  names  from  the 
arteries  they  accompany,  as  splenic,  gastric,  hepatic,  dia- 
phragmatic, suprarenal  and  renal,  superior  mesenteric,  inferior 
mesenteric,  aortic  and  spermatic.  The  ultimate  distribution  of 
the  branches  of  the  solar  plexus  is  to  the  muscular  and  secre- 
tory tissues  of  all  the  abdominal  viscera,  and  to  the  muscular 
coat  of  the  arteries  supplying  these  viscera.  This  great  plexus  is 
the  vaso-motor  center  for  the  abdominal  viscera.  "It  is  con- 
nected with  almost  every  organ  in  the  body,  with  a  supremacy 
over  visceral  circulation,  with  a  control  over  visceral  secre- 
tion and  nutrition,  with  a  reflex  influence  over  the  heart  that 
often  leads  to  fainting,  and  may  even  lead  to  fatality."- -"Ab- 
dominal Brain,"  Page  76. 

Function. — We  find  that  the  great  and  the  small 
splanchnics  and  right  pneumogastric  are  the  chief  contributors 
to  the  solar  plexus,  and  in  order  to  get  a  clear  idea  of  the  func- 
tions of  this  plexus,  we  may  tabulate  them  as  follows : 


132  PKINCIPLES  OF  OSTEOPATHY. 

ist:     Viscero-motor  to  stomach,  small  intestines,  as  far  V 
as  sigmoid  flexure,  per  pneumogastric. 

2nd :     Sensory  to  stomach  and  small  intestines,  per  pneu- 
mogastric. 

"If  the  pneumogastric  nerve  be  divided  during  full  di- 
gestion in  a  living  animal,  in  which  a  gastric  fistula  has  been 
established,  so  that  the  interior  of  the  stomach  can  be  ex- 
amined, the  muscular  contractions  will  be  observed  to  cease 
instantly;  the  mucous  membrane  to  become  pale  and  flaccid; 
the  secretion  of  the  gastric  juice  to  be  arrested,  and  the  organ 
to  have  become  insensible.  There  can  be  no  doubt,  also,  that 
stimulation  of  the  pneumogastric  nerves  causes  the  stomach 
to  contract,  and  that  digestion  may,  to  a  certain  extent,  at 
least,  be  re-established  by  stimulation  of  the  peripheral  ex-/ 
tremities  of  the  divided  nerves." — (Chapman'  Phys.,  Page 
680.) 

3rd :     Viscero-inhibitory,  per  splanchnics. 

4th:     Vaso-motor,  per  splanchnics. 

5th:     Sensory,  per  splanchnics. 

6th:     Sensory,  per  pneumogastric  and  splanchnics. 

The  fibres  of  the  great  and  small  splanchnics  come  from 
the  sympathetic  ganglia  in  the  dorsal  region,  sixth  to  eleventh. 

These  ganglia  may  receive  fibres  from  some  of  the  upper 
dorsal. 

Centers. — The  facts  just  stated  give  us  a  foundation 
for  osteopathic  treatment  to  influence  motion,  sensation,  se- 
cretion, and  vaso-motion  in  the  abdominal  viscera.  The  area 
in  the  vertebral  column  which  we  may  consider  as  containing 
centers  for  these  various  functions  lies  between  the  sixth  and 
eleventh  dorsal  spines.  The  fibres  from  this  region  have  a 
segmental  distribution  to  the  abdominal  viscera;  therefore,  the 
stomach,  liver,  gall  bladder,  spleen  and  intestines,  each  have 
a  limited  portion  of  this  area  which  is  their  special  center;  at 
least,  painful  sensations  are  reflexed  from  them  to  a  definite 
point  in  the  vertebral  column  between  the  sixth  and  eleventh 
dorsal  spines.  The  enormous  regulative  influence  which  can 
be  excited  by  an  osteopathic  treatment  in  this  area  is  being 
demonstrated  daily. 


PKIXCIPLES   OF   OSTEOPATHY.  133 

We  have  already  mentioned  the  fact  that  the  intestines 
will  contract  after  being  separated  from  the  body,  thereby, 
proving  that  the  intrinsic  power  to  cause  movement  lies  in  the 
nervous  mechanism  in  the  gut  walls.  Keep  constantly  in 
mind  the  regulative  character  of  the  impulses  which  enter  the 
"abdominal  brain''  over  the  pneumogastric  and  splanchnic 
nerves. 

The  vaso-motor  phenomena  in  this  area  have  been  dis- 
cussed in  another  chapter. 

Hypogastric  Plexus — Location  and  Formation. — The 
great  re-organizing  center  for  the  pelvic  viscera  is  called  the 
hypogastric  plexus,  which  lies  anterior  to  the  fifth  lumbar 
vertebra.  It  is  formed  by  a  continuation  of  fibres  from  the 
aortic  plexus  which  are  joined  by  fibres  from  the  lumbar 
sympathetic  ganglia.  In  front  of  the  sacrum  the  plexus  divides 
into  two  portions,  which  join  the  pelvic  plexuses  lying  on  each 
side  of  the  rectum  and  bladder,  in  the  male,  and  of  the  rectum,  / 
vagina  and  bladder  in  the  female. 

Pelvic  Plexus. — These  pelvic  plexuses  contain  many 
small  ganglia,  and  are  joined  by  fibres  from  the  upper  sacral 
sympathetic  ganglia,  and  by  direct  branches  of  the  second, 
third  and  fourth  sacral  cerebro-spinal  nerves. 

Distribution. — The  branches  of  these  plexuses  are  dis- 
tributed on  the  coats  of  the  arteries  to  the  pelvic  viscera,  and 
frequently  enter  the  substance  of  the  organ. 

Subsidiary  Plexuses. — According  to  the  artery  fol- 
lowed, we  have  subsidiary  plexuses,  called  hemorrhoidal,  vis- 
ceral, prostatic,  vaginal,  and  uterine. 

Functions. — The  functions  of  the  pelvic  plexus  are  as 
follows : 

(i)   Vaso-constrictor,   (2)  vaso-motor,   (3)   sensory,   (4)  . 

viscero-inhibitor,  per  hypogastric  plexus. 

(5)    Motor  to  rectum,  vagina  and  bladder,   (6)   sensory  \ 
to  rectum,  vagina  and  bladder,  (7)  vaso-dilator  to  sexual  or-  f 
gans,  erectile  tissue,  (8)  viscero-constrictor  to  neck  of  uterus, 
per  second,  third  and  fourth  sacral. 

Summary. — With  ihe   arrangement   and   functions   of 


134  PRINCIPLES   OF  OSTEOPATHY. 

these  nerves  well  in  mind,  we  recognize  two  paths  over  which 
we  can  influence  the  pelvic  viscera : 

1 i )  Sensory  influences  may  be  reflexed  through  the  hypo- 
gastric  plexus,  and  thence  to  the  second  lumbar ;  or,  they  may 
pass  over  sacral  nerves  to  the  same  point,  second  lumbar.     In 
connection  with  disturbance  of  the  pelvic  viscera,  pain  may 
be  reflexed  on  to  the  back  of  the  sacrum,  or  to  an  area  around 
the  second  lumbar.     Disturbance  of  function    in    the    uterus 
causes  reflex  sensitiveness  at  fourth  and  fifth  lumbar. 

(2)  Vaso-constrictor  influences  come  through  hypogastric 
plexus  from  spinal  nerves  about  second  lumbar. 

(3)  Vaso-dilator  influences   come   directly  to  the  pelvic 
plexus  from  second  and  third  sacral  nerves ;  nervi  erigentes. 

(4)  Viscero-motor  influences  chiefly  from   second,   third 
and  fourth  sacral. 

(5)  Viscero-inhibitory   influences,  chiefly  through  hypo- 
gastric  plexus,  probably  from  upper  lumbar  spinal  nerves. 

We  have  therefore  a  vaso-constrictor  center  for  pelvic 
viscera  at  second  lumbar;  a  vaso-dilator  and  motor  center 
at  second  and  third  sacral. 

Automatic  Visceral  Ganglia. — The  last  portion  of  the 
sympathetic  is  but  little  known,  and  physiologists  have  re- 
frained from  speculating  on  it  until  more  definite  knowledge 
is  obtained. 

Byron  Robinson  mentions  a  number  of  "automatic  vis- 
ceral ganglia"  situated  in  the  walls  of  the  hollow  viscera.  The 
fact  that  the  heart,  intestines,  uterus,  bladder  and  fallopian 
tubes  will  contract  rhythmically  in  response  to  mechanical 
stimulation  after  all  nerve  connections  are  severed,  seems  to 
prove  the  existence  of  ganglia  in  the  walls  of  these  viscera 
which  are  capable  of  receiving  sensation  and  sending  out 
motor  impulses. 

Conclusions. — We  will  therefore  conclude  that  the 
sympathetic  system  can  act  independently  of  the  cerebro- 
spinal ;  that  it  receives  sensation,  and  initiates  motion ;  gives 
tone  to  the  arteries,  and  controls  secretion.  We  influence  the 
functions  of  the  sympathetic  through  its  connection  with  the 
cerebro-spinal  system. 


PRINCIPLES  OF  OSTEOPATHY.  135 


CHAPTER  VII. 


HILTON'S  LAW. 

In  the  years  1860-61-62  a  series  of  lectures  was  delivered 
by  John  Hilton,  F.  R.  S.,  F.  R.  C.  S.,  "On  the  Influence  of 
Mechanical  and  Physiological  Rest  in  the  Treatment  of  Ac- 
cidents and  Surgical  Diseases,  and  the  Diagnostic  Value  of 
Pain."  These  lectures  were  afterward  published  in  book 
form  under  the  title  of  "Rest  and  Pain."  This  book  is  a 
medical  classic  and  worthy  of  careful  perusal  by  all  students 
of  medicine. 

The  careful  observations  and  reasonings  therefrom  which 
are  reported  in  "Rest  and  Pain"  explain  many  of  the  phe- 
nomena noted  in  osteopathic  practice.  We  desire  to  give  all 
due  honor  to  this  man  who  was  so  far  in  advance  of  his 
time. 

We  shall  quote  a  few  paragraphs  from  "Rest  and  Pain" 
which  have  a  direct  bearing  on  osteopathic  methods  of  diag- 
nosis and  therapeutics. 

The  Law  Stated. — After  careful  study  of  the  distribu- 
tion of  nerves  throughout  the  body,  Hilton  sums  up  his  ob- 
servations in  a  terse  sentence  which  we  choose  to  call  a  law. 
"The  same  trunks  of  nerves  whose  branches  supply  the  groups 
of  muscles  moving  a  joint,  furnish  also  a  distribution  of 
nerves  to  the  skin  over  the  insertion  of  the  same  muscles,  and 
the  interior  of  the  joint  receives  its  nerves  from  the  same 
source/' 

Hilton  further  states  that  "Every  fascia  of  the  body  has  a 
muscle  attached  to  it,  and  that  every  fascia  throughout  the 
body  must  be  considered  as  a  muscle." 

Methods    of    Studying    Anatomy. — These     statement?. 


136  PRINCIPLES  OF  OSTEOPATHY. 

lead  us  to  a  closer  study  of  each  joint  and  its  controlling 
muscles  and  governing  nerve  or  nerves.  We  may  study 
anatomy  under  artificial  divisions  such  as  Osteology,  Syndes- 
mology,  Myology,  etc.,  and  still,  after  securing  an  accurate 
technical  knowledge  of  details,  we  have  nothing  of  practical 
value.  It  is  in  the  correlation  of  these  tissues  with  their  in- 
terdependence quite  fully  understood  that  we  have  a  working 
knowledge.  With  this  thought  of  the  influence  of  one  tissue 
on  another  and  the  harmonious  action  secured  by  the  com- 
paratively varied  distribution  of  the  nerve  trunks,  we  find  a 
new  and  vital  interest  in  anatomy. 

This  law  is  based  upon  the  facts  of  anatomy  and  physi- 
ology, and  makes  our  concrete  knowledge  of  these  subjects 
of  constant  practical  value  in  both  diagnosis  and  therapeutics. 
This  law  shows  us  the  "why"  of  certain  vital  and  mechanical 
manifestations,  and  teaches  us  practical  methods  of  treat- 
ment. 

Example  of  Hilton's  Law. — An  example  of  Hilton's 
law  is  the  distribution  of  the  sciatic  nerve  to  the  ankle.  The 
muscles  moving  the  joint,  the  synovial  membrane  and  most 
of  the  skin  over  the  joint  are  all  innervated  by  it. 

The  Knee. — The  knee  has  three  nerves.  Each  one  has 
a  motor  and  sensory  control.  The  extensor  muscles  and  the 
skin  over  them  is  innervated  by  the  anterior  crural.  The  flexor 
muscles  and  the  skin  over  them  is  innervated  by  the  sciatic. 
The  obturator,  in  addition  to  these  nerves,  furnishes  sensory 
filaments  to  the  synovial  membrane.  All  the  joints  of  the 
body  may  be  examined  in  the  light  of  this  law.  The  same 
segment  of  the  central  nervous  system  which  gives  off  a 
purely  motor  nerve  trunk,  gives  off  also  a  sensory  nerve  whose 
filaments  are  distributed  over  the  same  area.  Thus  it  is  some- 
times necessary  to  go  to  the  central  nervous  system  to  dis- 
cover this  association  of  motor  and  sensory  distribution.  In 
practice  we  always  do  this,  because  it  is  easier  to  work  from 
the  center  of  the  areas  of  distribution. 

The  Object  of  Such  a  Distribution. — Hilton  says :  "The 
object  of  such  a  distribution  of  nerves  to  the  muscular  and  ar- 
ticular structures  of  the  joints,  in  accurate  association,  is  to 


PRINCIPLES  OF  OSTEOPATHY.  137 

insure  mechanical  and  physiological  consent  between  the  ex- 
ternal muscular,  or  moving  force,  and  the  vital  endurance  of 
the  parts  moved,  namely,  of  the  joints,  thus  securing  in  health 
a  true  balance  of  force  and  friction  until  deterioration  occurs." 

''Without  this  nervous  association  in  the  muscular  and 
articular  structures,  there  could  be  no  intimation  by  the  internal 
parts  of  their  exhausted  condition."  "Again,  through  the 
medium  of  the  muscular  and  cutaneous  nervous  association 
great  security  is  given  to  the  joint  itself  by  those  muscles  being 
made  aware  of  the  point  of  contact  of  any  extraneous  force  or 
violence.  Their  involuntary  contraction  instinctively  makes 
the  surrounding  structures  tense  and  rigid,  and  thus  brings 
about  an  improved  defence  for  the  subjacent  structures." 

The  Uniformity  of  the  Law. — "This  articular,  muscu- 
lar and  cutaneous  distribution  of  the  nerves  is,  in  my  opinion, 
a  uniform  arrangement  in  every  joint  in  the  body.  We  may 
find  numerous  illustrations  of  the  same  method  of  distribution 
in  other  parts  of  the  body,  which  have  the  same  definite  re- 
lations to  each  other,  and  in  this  respect  present  the  same 
physiological  and  mechanical  arrangement  observable  in  joints. 
.  This  same  principle  of  arrangement,  anatomic- 
ally, physiologically,  and  pathologically  considered,  is  to  be 
observed  with  an  equal  degree  of  accuracy  in  the  serous  and  in 
the  mucous  membrane.  Thus  considered,  it  presents  a  prin- 
ciple, which,  if  it  has  any  application  in  practice,  must  be  one 
certainly  of  large  extent." 

Precision  of  Nervous  Distribution  to  Muscles. — "The 
great  precision  with  which  muscles  are  supplied  by  their  nerves 
is  worthy  of  remark;  and  is  such  that  if  we  have  before  us  a 
contracted  muscle,  we  may  be  sure  of  the  nerve  which  must 
be  the  medium,  or  the  direct  cause  of  it." 

"In  studying  the  supply  of  nerves  to  muscles  over  every 
part  of  the  body,  we  find  a  great  degree  of  precision,  which 
marks  one  difference  between  their  distribution  and  that 
of  the  arteries." 

Indications  for  Use  of  Therapeutics. — "I  should  say  in 
aid  of  other  means,  employ  this  cutaneous  distribution  of 
nerves  as  a  road  or  means  toward  relieving  pain  and  irritation 


138 


PEINCIPLES  OF  OSTEOPATHY. 


a  -ipinal     Cord 

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Fi^.  30.—  Drawn  by  J.  E.  Stuart,  D.  O. 


PRINCIPLES   OF   OSTEOPATHY.  139 

in  the  joint..  You  thus  quiet  the  muscles,  prevent  extreme 
friction,  and  reduce  muscular  pressure  and  spasm.  Thera- 
peutics may  certainly  reach  the  interior  of  this  joint  and  its 
muscles  through  the  medium  of  the  nerves  upon  the  surface 
of  the  skin,  and  so  induce  physiological  rest  to  all  the  parts 
concerned  in  moving  the  joint.  ....  The  advantage 
to  be  derived  arises  in  this  way:  Sensibility  of  the  filaments 
supplying  the  skin  being  reduced,  that  influence  is  propagated 
through  the  sensitive  nerves,  to  the  interior  of  the  joint,  and  to 
the  muscles  moving  a  joint.  This  diminution  of  sensibility 
tends  to  give  quietude  or  perfect  rest  to  the  interior  of  the  joint, 
which  is  one  of  the  most  important  elements  towards  the  suc- 
cessful issue  of  the  treatment  of  cases  of  this  kind." 

The  Use  of  Hilton's  Law  in  Physical  Diagnosis. — Hil- 
ton's law  is  applicable  in  physical  diagnosis.  The  osteopath 
makes  constant  use  of  the  superficial  expressions  of  nerve 
activity.  After  having  learned  the  whole  course,  distribu- 
tion and  central  connections  of  the  nerve,  we  can  judge 
rightly  as  to  the  structures  involved,  by  noting  the  physiologi- 
cal conditions  of  all  the  structures  innervated  by  a  definite 
nerve  trunk.  Hilton  applied  his  law  entirely  from  the  physio- 
logical side,  i.  e.,  he  observed  changes  in  the  relations  of  joint 
structures,  but  considered  the  deformity  as  due  to  excessive 
physiological  action  of  the  muscles  in  their  effort  to  secure  rest 
for  the  joint  surfaces.  This  is  largely  true,  but  he  did  not 
question  how  the  process  was  initiated.  The  osteopath  seeks  a 
point  of  stimulus  to  the  nerves  controlling  a  joint  or  other 
structure,  believing  that  it  is  of  little  value  to  anaesthetize 
nerve  endings  and  give  rest  so  long  as  this  stimulus  is  allowed 
to  arouse  impulses  in  the  nerve  fibres. 

Comparison  of  Methods. — To  compare  methods  of  us- 
ing Hilton's  Law,  we  will  note  one  of  his  cases,  and  a  similar 
one  treated  osteopathically.  In  Chapter  VIII  of  "Rest  and 
Pain"  he  describes  a  case  of  inflammation  of  the  shoulder 
joint,  and  mentions  that  the  joint  is  fixed  in  a  position  of  rest 
as  a  result  of  the  association  of  nerves  to  the  synovial  mem- 
brane, the  muscles  of  the  joint  and  the  skin  over  the  joint. 
Anaesthesia  releases  the. fixedness  of  the  joint,  because  the 


140  PKINCIPLES   OF   OSTEOPATHY. 

muscles  do  not  contract  after  the  sensory  impulses  are  dead- 
ened by  the  anaesthetic.  He  says  "Therapeutics  may  certainly 
reach  the  interior  of  this  joint  and  its  muscles  through  the 
medium  of  the  nerves  upon  the  surface  of  the  skin,  and  so 
induce  physiological  rest  to  all  the  parts  concerned  in  moving 
the  joint.  I  mean  to  say  that  these  nerves  upon  the  surface 
of  the  skin  being  in  direct  association  with  the  interior  of  the 
joint  itself,  we  may  reduce  the  muscular  spasm  as  well  as  the 
sensibility  of  the  interior  portion  of  the  joint,  by  applying  our 
anaesthetics  with  accuracy  and  with  sufficient  intensity  upon 
the  exterior  of  the  deltoid  muscle,  over  the  distribution  of 
these  sensitive  filaments.  The  thought  will  occur  to  you  at 
once  that  there  is  nothing  very  remarkable  in  this  opinion, 
and  that  is  quite  true.  The  embrocations,  however,  which 
would  ordinarily  be  suggested  for  this  purpose,  are  not  of  a 
character  sufficiently  potent  to  alleviate  the  pain  of  the  patient, 
and  are,  I  believe,  seldom  employed  with  a  definite  idea  in  the 
mind  of  the  prescriber.  I  would  suggest  that  we  should  em- 
ploy our  fomentations  strongly  medicated  with  bella-donna, 
with  opium  or  with  hemlock,  instead  of  using  mere  fomentation 
of  hot  water.  Some  will  say,  'Oh,  hot  water  is  quite  as  good ;' 
but  I  can  assure  you  practically  that  it  is  not  so." 

You  will  note  that  he  makes  use  of  the  cutaneous  reflexes 
to  affect  the  interior  of  the  joint. 

A  recent  case,  corresponding  we  believe,  was  treated 
osteopathically  with  marked  success.  The  inflammation  in  the 
shoulder  joint  was  not  traumatic  in  origin  nor  did  it  appear 
to  be  rheumatic  in  character.  Hot  fomentations  would  give 
great  relief,  but  did  not  give  sufficient  rest  to  the  joint  to  permit 
of  a  cure.  The  fear  was  entertained  that  longer  rest  of  the 
articulation  would  result  in  adhesion  and  loss  of  function  in 
the  joint.  Since  the  circumflex  nerve  appeared  to  be  the  one 
involved,  a  careful  examination  was  made  of  the  articulations 
between  the  sixth  and  seventh  cervical  vertebrae.  The  cir- 
cumflex nerve  is  made  up  largely  of  fibres  from  the  sixth  cer- 
vical nerve  trunk.  Tension  and  tenderness,  together  with  slight 
rotation  of  the  sixth  cervical  were  noted  at  this  point.  The 
osteopath,  instead  of  working  over  the  area  of  distribution  of 


PEIXCIPLES   OF  OSTEOPATHY.  141 

the  circumflex,  centered  his  work  upon  this  articulation  to 
bring  about  right  relations  between  the  sixth  and  seventh  cervi- 
cal vertebrae.  Tension  and  irritation  were  removed.  The 
circumflex  nerve  ceased  to  manifest  any  undue  irritation.  The 
osteopath  almost  invariably  works  from  the  center  to  periphery 
instead  of  the  reverse. 

Herpes  Zoster. — An  example  of  the  osteopath's  use,  or 
rather  recognition  of  Hilton's  law :  A  case  of  Herpes  Zoster 
located  along  the  course  of  the  left  fifth  intercostal  nerve  was 
given  a  grave  prognosis  by  a  homeopathic  physician.  The 
patient  visited  an  osteopath  immediately,  hoping  that  some  re- 
lief might  be  found  for  the  intolerable  pain.  The  eruption 
extended  from  the  spine  to  the  median  line  in  front,  forming  a 
band  about  one  inch  wide.  The  fifth  rib  was  found  rotated 
downward,  thus  lessening  the  fifth  intercostal  space  and  press- 
ing on  the  nerve  at  some  point  in  its  course.  This  rib  was 
raised,  even  though  the  osteopath's  fingers  rested  directly  upon 
the  eruption,  in  order  to  force  the  rib  upward.  The  result 
was  most  gratifying.  Pain  decreased  almost  immediately, 
and  there  was  a  rapid  change  in  the  appearance  of  the  erup- 
tion, the  firey  red  giving  place  to  a  paler  color.  Those  papules 
which  were  just  forming  subsided,  and  those  which  had  formed 
vesicles  began  immediately  to  scab. 

The  Distribution  of  an  Intercostal  Nerve. — The  distri- 
bution of  an  intercostal  nerve  is  to  the  pleura,  intercostal  mus- 
cles and  skin  over  these  muscles  thus  corresponding  to  the  dis- 
tribution of  nerve  trunks  to  the  synovial  membrane  of  a  joint, 
the  muscles  moving  the  joint  and  the  skin  covering  the  joint. 

The  patient  could  not  stand  erect,  lifting  the  arm  caused 
increase  of  pain,  likewise  inspiration  was  lessened  because  it 
caused  pain.  Hilton  would  say  that  these  movements  were 
curtailed  to  give  physiological  rest.  From  the  osteopathic  stand- 
point, they  are  reflexes  which  are  not  reparative  in  character, 
hence  must  be  eliminated.  Every  movement  which  tended  to 
separate  the  fifth  and  sixth  ribs  caused  pain,  hence  the  patient 
refrained  from  making  them.  The  osteopath  separated  these 
ribs,  even  though  the  process  of  doing  so  caused  pain.  The 
structural  defect  causing  the  irritation  was  removed. 


142  PRINCIPLES  OF  OSTEOPATHY. 

Some  of  the  Evil  Results  of  Rest. — If  we  are  to  give 
rest  to  structures  in  which  pain  is  located,  we  will  help  to  fill 
the  world  with  stiff  joints  and  serous  adhesions,  to  say  nothing 
of  the  far  reaching  after  effects  of  these  structural  defects 
upon  the  functional  activity  of  the  nervous  system. 

Hilton's  law  may  be  called  an  anatomical  law ;  there  do 
not  appear  to  be  any  exceptions  to  it,  especially  when  supple- 
mented by  his  statement  that  "every  fascia  of  the  body  has  a 
muscle  attached  to  it,  and  every  fascia  throughout  the  body 
must  be  considered  as  the  insertion  of  a  muscle."  This  carries 
the  influence  of  motor  nerves  to  points  covered  by  their  sensory 
companions. 

Head's  Law. — Another  law,  or  in  this  case  a  compre- 
hensive statement,  has  been  made  by  Head  in  his  work  on  the 
"Brain."  This  is  a  statement  of  physiological  transference  of 
pain  from  its  point  of  origin  to  a  point  of  conscious  sensation. 
This  physiological  lazv  is  stated  as  follows :  "When  a  painful 
stimulus  is  applied  to  a  part  of  low  sensibility  in  close  central 
connection  with  a  part  of  much  higher  sensibility,  the  pain  pro- 
duced is  felt  in  the  part  of  higher  sensibility  rather  than  in  the 
part  of  lower  sensibility  to  which  the  stimulus  was  applied." 

Application  of  the  Law. — This  physiological  law  can 
be  applied  in  two  ways.  First,  we  may  consider  the  relative 
sensibility  of  different  portions  of  a  nerve  trunk.  If  a  stimulus 
is  applied  to  a  nerve  trunk  at  some  point  in  its  course  between 
its  origin  and  distribution,  the  pain  caused  by  the  stimulus  will 
be  felt  in  the  area  of  distribution  of  the  fibres  of  this  nerve 
trunk  rather  than  at  the  point  where  the  stimulus  is  applied. 
The  skin,  mucous  or  serous  membrane  and  muscle  in  which 
sensory  nerves  end  are  areas  of  high  sensibility  compared  with 
the  trunk  of  the  nerve.  The  brain  is  conscious  of  only  the 
areas  of  distribution  of  the  sensory  nerves,  hence  stimuli  ap- 
plied at  the  points  of  low  sensibility  are  referred  to  the  areas 
of  high  sensibility.  Thus  all  lesions  causing  pressure  upon 
nerve  trunks  cause  pain,  contraction,  or  perversion  of  secretion 
in  the  areas  of  distribution.  The  patient  is  not  thoroughly 
conscious  of  any  location  but  the  area  of  distribution  which  is 
an  area  of  high  sensibility. 


PRINCIPLES  OF  OSTEOPATHY.  143 

The  cases  described  under  Hilton's  law  are  applicable  here. 
In  the  case  of  inflamed  shoulder  joint  the  patient  was  not 
conscious  of  the  irritation  at  the  spinal  column, — the  rotated 
vertebra, — this  was  an  area  of  low  sensibility  in  the  course  of 
the  nerve  trunk.  The  brain  attributed  all  the  trouble  to  the 
terminations  of  the  nerves  in  the  tissues  of  the  joint.  All  of  the 
reflexes  acted  accordingly. 

The  second  application  of  this  law  is  to  the  relative  inten- 
sity of  areas  of  high  sensibility.  The  areas  in  which  sensory 
nerves  end  are  all  areas  of  high  sensibility,  but  some  are 
higher  than  others.  We  note  in  practice  that  sometimes  a 
nerve  trunk  which  supplies  several  structures  will  manifest 
pain  in  a  portion  of  its  area  of  distribution  which  is  not  the 
part  in  which  the  irritation  is  located.  For  example,  the 
sensory  portion  of  the  obturator  nerve  is  disturbed  to  the  hip 
joint  and  skin  on  the  inner  side  of  the  knee.  The  skin  seems 
to  be  an  area  of  higher  sensibility  than  the  interior  of  the  hip 
joint,  because  in  disease  of  the  hip  joint  the  patient  frequently 
complains  of  pain  in  the  cutaneous  area  rather  than  in  the 
joint  where  the  actual  disease  is  located. 

The  Viscera. — The  viscera  are  normally  non-sensitive, 
i.  e.,  we  are  not  conscious  of  possessing  viscera.  The  pressure 
of  food  in  the  stomach  and  the  beat  of  the  heart  make  no 
impression  on  our  consciousness;  and  so  it  is  with  all  parts 
of  the  body  governed  by  sympathetic  nerves.  The  viscera  are 
areas  of  low  sensibility,  not  low  irritability,  for  they  are  richly 
supplied  with  sensory  nerves,  upon  the  stimulation  of  which 
active  functioning  depends.  The  response  to  stimuli  of  sensory 
nerves  in  viscera  is  rapid,  but  normally  this  response  takes 
place  entirely  outside  of  our  consciousness,  the  impression  is 
not  recognized  as  coming  from  the  viscera,  but  from  a  remote 
area  of  high  sensibility  in  close  central  connection  with  the 
less  sensitive  area.  As  an  example,  pain  is  felt  in  the  right 
shoulder,  as  a  result  of  hyperaemia  of  the  liver.  The  pres- 
sure upon  sensory  nerves  in  the  liver  does  not  cause  pain  in 
the  liver,  but  refers  it  to  a  more  sensitive  area — the  skin  and 
muscles  of  the  right  shoulder. 

Chronic  inflammation  of  the  stomach  may  cause  no  con- 


144  PE1NCIPLES  OF  OSTEOPATHY. 

sciousness  of  pain  in  that  organ,  but  may  cause  intense  ach- 
ing in  the  mid-dorsal  region. 

Nerves  of  Conscious  Sensation. — Cerebro-spinal  nerves 
are  nerves  of  consciousness,  and  seem  to  have  the  duty  of  reg- 
istering on  the  sensorium  of  our  brains  not  only  their  own  im- 
pressions, but  the  impressions  derived  from  that  part  of  the 
sympathetic  system  in  closest  central  connection  with  them. 

A  close  study  of  the  segmental  distribution  of  spinal 
nerves  and  their  connection  with  the  sympathetic  system  by 
the  rami-communicantes  will  make  Head's  law  of  practical 
value  in  osteopathic  diagnosis  and  therapeutics. 


CHAPTER  VIII. 


LESIONS. 

Definition. — We  have  now  laid  a  foundation  for 
the  analysis  of  those  structural  changes  which  we  designate 
as  lesions.  The  word  lesion  is  used  by  Osteopaths  to  desig- 
nate something  more  than,  "an  injury,  hurt  or  wound  in  any 
part  of  the  body."  (Gould.)  Any  structural  change  which 
affects  the  functional  activity  of  any  tissue  is  called  a  lesion. 
There  may  be  structural  changes  which  are  very  evident  to 
palpation  but  do  not  affect  functional  activity  and  therefore 
are  not  lesions.  A  lesion  is  not  only  a  structural  change 
but  such  a  change  as  influences  function  detrimentally.  Fig. 
41  illustrates  a  structural  change  without  detrimental  in- 
fluence on  function,  while  Fig.  42  illustrates  a  true  lesion. 
The  pressure  of  these  structural  lesions  exerted  on  the 
media  of  communication  and  exchange,  nerves  and  blood- 
vessels, is  believed  to  be  the  chief  element  active  in  pro- 


PEINCIPLES  OF  OSTEOPATHY.  145 

ducing  and  maintaining  functional  disorders.  This  is  the 
central  principle  of  osteopathic  practice. 

Lesions  may  be  present  in  any  tissue,  but  their  exis- 
tence is  most  easily  recognized  in  bone,  ligament  and  muscle. 
Dislocations  and  subluxations  of  bones,  thickened  ligaments 
and  contracted  muscles  constitute  the  usual  varieties  of 
lesions.  A  true  lesion  is  usually  palpable ;  the  functional 
disturbance  is  related  anatomically  and  physiologically; 
there  is  hyperaesthesia  at  the  palpable  area. 

These  three  conditions  constitute  the  characteristics  of 
the  lesion  as  it  is  designated  by  the  osteopath.  Its  palpa- 
bility may  vary  between  very  wide  limits;  the  anatomical 
and  physiological  association  between  the  location  of  the 
structural  change  and  functional  derangement  may  be  di- 
rect or  indirect ;  the  hyperaesthesia  distinct  or  indistinct, 
still,  the  diagnostician  is  justified  in  centering  attention  upon 
the  lesion  if  a  reasonable  amount  of  association  can  be  de- 
tected. 

History. — Osteopaths  are  not  the  first  or  only  physicians 
who  have  used  the  spine  as  a  means  of  diagnosis  as  well  as 
an  area  upon  which  to  concentrate  therapeutic  methods. 
It  is  interesting  and  instrucive  to  note  the  steps  in  the  devel- 
opment of  the  knowledge  of  spinal  conditions  and  of  the 
indications  of  remote  functional  disturbances  which  are 
registered  there. 

Subjective  symptoms  precede  any  attempt  to  discover 
objective  evidences  of  disease.  It  was  early  noted  by  physi- 
cians that  patients  could  not  be  relied  upon  to  interpret  their 
own  symptoms.  This  led  to  efforts  to  discover  symptoms 
which  were  independent  of  the  patients'  imperfect  per- 
ceptions. 

Palpation  would  naturally  be  used  at  the  areas  com- 
plained of  by  the  patient.  Since  the  brain  takes  cogni- 
zance of  only  the  peripheral  areas  of  distribution  of  sensory 
nerves  instead  of  the  whole  course  of  the  nerve  fibres,  the 
physician  might  still  be  misled  in  applying  palpation,  be- 
cause he  would  be  largely  governed  by  the  patient's  sensory 


146  PRINCIPLES  OF  OSTEOPATHY. 

impressions.  Palpation  made  with  reference  to  a  reali- 
zing sense  of  the  distribution  and  function  of  the  nervous 
system,  becomes  a  more  satisfactory  means  of  diagnosis. 
As  the  knowledge  of  the  nervous  system  increased,  attention 
was  called  more  and  more  to  the  spinal  column,  on  account 
of  its  relations  to  the  great  nervous  mass  within  it.  Pal- 
pation of  the  spinal  column  demonstrated  the  existence 
of  sensitive  areas,  associated  with  visceral  or  other  disor- 
ders; therefore,  hyperaesthetic  areas  are  the  first  diagnostic 
points  mentioned  in  medical  literature,  in  regard  to  the 
spinal  lesion.  Such  hyperaesthetic  areas  were  considered 
as  evidence  of  spinal  irritation;  that  is,  irritation  of  the 
spinal  cord.  The  first  reference  to  spinal  irritation  which 
I  have  found,  is  contained  in  a  monograph  entitled  "A  Treat- 
ise on  Neuralgic  Diseases,  Dependent  on  Irritation  of  the 
Spinal  Marrow  and  Ganglia  of  the  Symphetic  Nerve,"  by 
Thomas  Pridgin  Teale — 1834.  He  quotes  a  letter  from 
Mr.  R.  P.  Player  to  the  editor  of  the  Quarterly  Journal 
of  Science,  "On  Irritation  of  the  Spinal  Nerves,"  dated 
December  ioth.,  1821,  as  follows:  "I  take  the  liberty  to 
submit  to  your  notice  a  pathological  fact,  which  has  not, 
to  the  best  of  my  knowledge,  been  generally  remarked  and 
attention  to  which,  so  far  as  my  own  experience  goes, 
promises  some  diminution  of  those  difficulties  with  which 
the  healing  art  has  to  contend.  Most  medical  practitioners 
who  have  attended  to  the  subject  of  Spinal  disease,  must 
have  observed  that  its  symptoms  frequently  resemble  va- 
rious and  dissimilar  maladies  and  that  commonly  every 
function  of  every  organ  is  impaired  whose  nerves  originate 
near  the  seat  of  the  disorder.  The  occurrence  of  pain  in 
distant  parts  forcibly  attracted  my  attention  and  induced 
frequent  examinations  of  the  spinal  column ;  and  after  some 
years'  attention,  I  considered  myself  enabled  to  state,  that 
in  a  great  number  of  diseases,  morbid  symptoms  may  be  dis- 
covered about  the  origins  of  the  nerves  which  pro- 
ceed to  the  affected  parts,  or  of  the  spinal  branches  which 
unite  them ;  and  that  if  the  spine  be  examined,  more  or 

^ 


PRINCIPLES  OF   OSTEOPATHY.  147 

less  pain  will  commonly  be  felt  by  the  patient  on  the 
application  of  pressure  about  or  between  those  vertebrae 
from  which  such  nerves  emerge. 

"This  spinal  affliction  may,  perhaps,  be  considered  as 
the  consequence  of  diseases,  but  of  its  existence  at  their 
commencement  any  one  may  satisfy  himself;  and  this  cir- 
cumstance, combined  with  the  success  which  has  attended 
the  employment  of  topical  applications  to  the  tender  parts 
about  the  vertebrae,  appears  to  indicate  that  the  cause  may 
exist  there.  Prejudice  sometimes  operates  against  ideas  of 
connection  so  remote ;  but  in  many  instances  patients  are 
surprised  at  the  discovery  of  tenderness  in  a  part,  of  whose 
implication  and  disease  they  had  not  the  least  suspicion.'' 

Dr.  Teale  brings  to  his  aid  in  the  exposition  of  his  subject 
some  interesting  corroboratory  observations  made  by  others 
and  recorded  in  the  medical  literature  of  that  period.  He 
quotes  Dr.  Darwell  in  an  interesting  paragraph  which  is  a 
faint  distant  undercurrent  of  Dr.  A.  T.  Still's  oft  repeated 
statement  concerning  the  interaction  of  nerves  and  the 
blood  stream.  The  passage  is  as  follows,  "If  however,  the 
nervous  system  is  more  or  less  connected  with  every 
function  of  the  animal  body;  if  the  circulation  of  the  blood, 
the  phenomena  of  the  respiration  and  the  operation  of  intel- 
lect, cannot  be  carried  on  without  its  intervention,  the  man- 
ner in  which  it  is  disregarded  can  not  but  be  a  most  impor- 
tant defect.  It  has  perhaps  in  great  measure  arisen  from  al- 
ways contemplating  the  brain  as  acted  upon  by  the  circula- 
tion and  never  reversing  the  order  of  review." 

One  of  the  best  expressed  concepts  of  the  nervous 
system  I  have  read  is  Dr.  Teale's  introduction  to  his  mono- 
graph. It  is  the  concept  which  is  being  more  clearly  taught 
in  osteopathic  colleges  than  in  those  of  other  schools  of 
medicine :  "The  term  Neuralgia  which  was  originally  em- 
ployed to  designate  certain  affections  of  nerves  attended 
with  severe  pain  has  of  late  with  great  propriety  been  ex- 
tended from  its  original  and  literal  signification,  to  many 
other  morbid  affections  of  nerves,  which  are  not  character- 


I48  PKINCIPLES  OF  OSTEOPATHY. 

ized  by  pain,  but  by  some  other  perverted  state  of  their 
functions. 

"Neuralgia  includes  within  its  range  a  great  variety 
of  diseases,  presenting  an  endless  diversity  both  in  their 
symptoms  and  in  the  parts  where  they  are  seated.  That 
such  variety  should  exist,  ceases  to  excite  surprise,  when  we 
consider  how  varied  are  the  functions  of  the  different  nerves, 
and  how  diversified  the  tissues  and  organs  to  which  they  are 
distributed. 

"To  the  attentive  observer  of  disease,  neuralgic  af- 
fections, under  the  more  extended  signification,  must  re- 
peatedly present  themselves.  The  skin  for  instance  may  be 
the  seat  of  every  degree  of  exalted  or  diminished  sensibility, 
from  the  slightest  uneasiness  to  the  most  acute  suffering 
and  from  the  most  trivial  diminution  of  sensibility  to  the 
complete  obliteration  of  feeling — symptoms  not  dependent 
upon  disease  affecting  the  different  tissues  of  the  part  but 
solely  referable  to  a  morbid  condition  of  the  sentient  nerves. 
The  voluntary  muscles  may  in  like  manner  indicate  in  a 
variety  of  ways  a  morbid  condition  of  the  nerves  with  which 
they  are  supplied.  They  may  be  affected  with  weakness, 
spasms,  tremors,  or  a  variety  of  other  disordered  states  in- 
cluded within  the  two  extremes  of  convulsion  and  paralysis. 
The  involuntary  muscles  may  have  the  harmony  of  their  ac- 
tions interrupted  from  a  morbid  condition  of  their  nerves; 
the  heart  may  be  affected  with  palpitation ;  the  vermicular 
motion  of  the  stomach  or  the  peristaltic  action  of  the  intes- 
tines may  be  subject  to  irregularity.  The  sensibility  of  the 
internal  organs  may  likewise  be  affected,  the  heart,  the 
stomach,  the  intestines,  being  the  seat  of  pain,  referable  to 
their  nerves,  and  independent  of  inflammation,  or  any  alter- 
ation of  structure.  The  secretions  may  also  undergo  al- 
terations, both  in  quantity  and  quality,  from  a  perverted 
agency  of  the  nerves  upon  which  they  depend.  Such  is 
a  very  imperfect  recital  of  the  various  morbid  affections 
which  may  be  included  under  the  term  Neuralgia,  and 
so  frequent  is  their  occurrence,  that  they  must  be  familiar 
to  every  practitioner.  They  are,  however,  often  perplex- 


PRINCIPLES   OF  OSTEOPATHY.  149 

ing  in  their  treatment  and  not  (infrequently  exhaust  the 
patience  of  the  afflicted  sufferer,  and  also  of  the  medical 
attendant. 

"The  difficulty  and  embarrassment  which  have  attended 
the  diagnosis  and  treatment  of  these  affections,  I  am  in- 
clined to  believe,  has  principally  arisen  from  mistaken 
views  of  their  pathology.  They  have  too  often  been  re- 
garded as  actual  diseases  of  those  nervous  filaments  which 
are  the  immediate  seat  of  the  neuralgia  instead  of  being  con- 
sidered as  symptomatic  of  disease  in  the  larger  nervous 
masses  from  which  those  filaments  are  derived ;  hence 
the  treatment  has  too  frequently  been  ineffectually  applied 
to  the  seat  of  neuralgia ;  instead  of  being  directed  to  the 
more  remote  and  less  obvious  seat  of  disease. 

"It  is  now  pretty  generally  admitted  as  a  pathological 
axiom,  that  disease  of  the  larger  nervous  masses,  as  the 
brain  and  spinal  marrow,  is  not  so  much  evinced  by  phe- 
nomena in  the  immediate  seat  of  disease,  as  in  those  more 
remote  parts  to  which  the  nerves  arising  fron;  the  diseased 
portion  are  distributed.  In  the  more  severe  forms  of  dis- 
ease, this  principle  is  readily  admitted  and  recognized. 
When  for  instance  one  half  of  the  body  shall  have  lost 
its  sensibility  and  the  corresponding  muscles  their  power 
of  action,  the  skin  and  the  muscle  are  not  regarded  as  the 
seat  of  disease,  but  the  brain  is  immediately  referred  to. 
In  the  slightest  forms  of  disease  of  the  brain  and  spinal 
marrow,  such  as  do  not  completely  obliterate  but  merely 
impair  or  pervert  the  functions  of  the  nerves — such  as  do 
not  paralyze  the  sentient  and  muscular  powers  of  the  part, 
but  produce  weakness,  tremors,  spasms,  etc.,  in  the  muscular 
system,  and  numbness  and  prickings,  pains  and  other 
morbid  feelings  in  the  nerves  of  sensation,  this  important 
principle,  which  as  strictly  obtains  as  in  the  former  in- 
stance, is  too  often  entirely  overlooked ;  and  a  numerous 
class  of  complaints  of  very  frequent  occurrence,  are  regarded 
as  nervous  or  spasmodic  diseases  of  the  part  affected,  instead 
of  being  considered  as  actual  diseases  of  that  portion  of 


ISO  PEINCIPLES  OF  OSTEOPATHY. 

the  brain  and  spinal  marrow  from  which  the  nerves  of  the 
part  are  derived. 

"The  same  pathological  principle  is,  I  believe  equally 
applicable  to  the  sympathetic  system  of  nerves ;  although 
it  may  be  difficult  to  establish  this  opinion  by  actual  ex- 
periment, yet  I  think  it  may  be  rested  upon  a  well  grounded 
analogy,  which  will  justify  us  in  regarding  the  nervous 
masses  of  the  ganglionic  system  as  bearing  the  same  rela- 
tion to  the  nerves  derived  from  them,  as  the  large  nervous 
masses  of  the  cerebro-spinal  system  bear  to  their  respective 
nerves.  Hence  many  nervous  affections  of  the  viscera  ought 
not  be  considered  as  diseases  of  the  viscera  themselves 
but  as  symptomatic  of  disease  in  those  particular  ganglia 
whence  their  nerves  are  derived. 

"Influenced  by  such  considerations,  I  have  for  a  few 
years  been  in  the  habit  of  treating  many  of  these  nervous 
affections  as  diseases  of  some  portion  of  the  spinal  marrow 
or  ganglia;  and  have  been  still  further  confirmed  in  my 
opinion  by  the  frequent  and  almost  uniform  coexistence  of 
tenderness  on  pressing  some  portion  of  the  vertebral  column 
and  the  circumstances  of  the  tender  portion  of  the  spine 
being  in  a  particular  situation  where  the  nerves  of  the 
affected  part  originate. 

"The  symptoms  of  spinal  irritation  consist  in  an  in- 
finite variety  of  morbid  functions  of  the  nerves  of  sensation 
and  volition  which  have  their  origin  in  the  spinal  marrow, 
and  the  parts  in  which  these  morbid  functions  are  exhibited, 
of  course,  bear  reference  to  the  distribution  of  the  spinal 
nerves. 

"The  morbid  states  of  sensation  include  every  variety, 
from  the  slightest  deviation  from  the  healthy  sensibility 
of  any  part,  to  the  most  painful  neuralgic  affections  on  the 
one  hand ;  and  to  complete  numbness  or  loss  of  feeling  on 
the  other;  including  pains  which  may  be  fixed  or  fugitive 
or  darting  in  the  direction  of  the  nerve,  pricking  and  ting- 
ling sensations,  a  sense  of  creeping  in  the  skin,  of  cold  water 
trickling  over  it,  and  numerous  other  states  of  perverted 
sensation  of  which  words  are  inadequate  to  convey  a 


PEIXCIPLES   OF  OSTEOPATHY.  151 

description.  In  the  muscular  system  we  find  weakness  or 
loss  of  power,  tremors,  spasms  or  cramps  and  sometimes 
a  tendency  to  rigidity. 

''These  symptoms  sometimes  exist  in  so  slight  a  de- 
gree that  the  patient  considers  them  unworthy  of  notice, 
and  only  admits  their  existence  when  particular  inquiry  is 
made  respecting  them  ;  the  only  complaint  which  he  makes 
being  of  an  unaccountable  sense  of  weakness  and  inability 
of  exertion.  In  other  cases  the  tremors  have  excited  alarm ; 
sometimes  the  neuralgic  pains  in  the  scalp  or  the  fixed  pain 
in  the  muscles,  particularly  when  it  occurs  in  the  intercostal 
muscles,  have  suggested  the  idea  of  serious  disease  in  the 
brain  or  in  the  lungs ;  and  when  the  pain  is  seated  in  the 
muscles  of  the  abdomen,  a  fear  that  some  organic  disease 
of  the  abdominal  viscera  has  taken  place  harrasses  the  mind 
of  the  patient.  The  muscular  weakness  in  some  cases  tend- 
ing to  paralysis  often  suggests  the  fear  of  apoplexy  or 
paralysis  from  cerebral  disease. 

"The  affection  is  often  of  very  protracted  duration, 
undergoing  alternate  variations  from  the  sanative  powers 
of  the  constitution  and  the  different  existing  causes  of 
disease.  There  are  many  individuals  in  whom  the  com- 
plaint has  existed,  in  varying  degrees  of  intensity  for  a 
series  of  years,  without  its  real  nature  having  been  sus- 
pected ;  the  patients  and  their  medical  attendants  having 
regarded  it  throughout  as  a  rheumatic  or  a  nervous  affec- 
tion. 

"In  this  complaint  tenderness  in  the  portion  of  the 
vertebral  column  which  corresponds  to  the  origin  of  the 
affected  nerves,  is  generally  in  a  striking  and  unequivocal 
manner  evinced  by  pressure.  In  some  instances  the  ten- 
derness is  so  great  that  even  slight  pressure  can  scarcely 
be  borne,  and  will  often  cause  pain  to  strike  from  the  spine 
to  the  seat  of  spasm  or  neuralgia. 

"This  affection  of  the  spinal  marrow  occasionally 
exists  throughout  its  whole  extent ;  more  frequently,  how- 
ever, it  is  confined  to  some  particular  portion,  and  occa- 
sionally is  seated  in  different  and  remote  portions  at  the 


152  PKINCIPLES  OF  OSTEOPATHY. 

same  time ;  the  particular  symptoms  and  tenderness  on 
pressure  indicating  the  affected  part. 

''The  symptoms  of  course  vary  considerably,  accord- 
ing to  the  particular  part  of  the  spine  which  is  affected, 
and  bear  reference  to  the  distribution  of  the  different 
spinal  nerves. 

"When  the  upper  cervical  portion  of  the  spinal  marrow 
is  diseased,  we  frequently  find  neuralgic  affections  of  the 
scalp ;  the  pain  strikes  in  various  directions  over  the  poste- 
rior and  lateral  parts  of  the  head ;  sometimes  the  twigs  in 
the  neighborhood  of  the  ear,  sometimes  those  which  ascend 
over  the  occiput  to  the  superior  part  of  the  scalp,  are  more 
particularly  the  seat  of  the  complaint;  the  nervous  twigs 
distributed  to  the  integuments  of  the  neck  are  occasionally 
affected,  the  pain  darting  across  the  neck  to  the  edge  of 
the  lower  jaw,  and  sometimes  encroaching  a  little  upon  the 
face.  These  neuralgic  diseases  frequently  assume  an  inter- 
mittent form,  the  paroxysms  generally  occuring  in  the 
evening.  A  stiff  neck  or  impaired  action  of  the  muscles 
moving  the  head  frequently  attend  the  affection  of  the 
upper  cervical  portion  of  the  spinal  marrow ;  and  occasion- 
ally the  voice  is  completely  lost,  or  suffers  alteration,  and 
the  act  of  speaking  is  attended  with  pain  or  difficulty. 

"Irritation  of  the  lower  cervical  portion  of  the  spinal 
marrow  gives  rise  to  a  morbid  state  of  the  nerves  of  the 
apper  extremities,  shoulders,  and  integuments  at  the  upper 
part  of  the  thorax.  Pains  are  felt  in  various  parts  of  the 
arm,  shoulder,  and  breast;  sometimes  the  pain  takes  the 
course  of  the  anterior  thoracic  branches  of  the  brachial 
plexus,  occasionally  the  pain  is  fixed  at  some  point  near  the 
clavicle,  scapula  or  shoulder  joint  at  the  insertion  of  the 
deltoid,  or  near  the  elbow  or  shoots  along  the  course  of 
some  of  the  cutaneous  nerves.  Frequently  one  or  both  of 
the  mammae  become  exquisitely  sensible  and  painful  on 
pressure,  and  some  degree  of  swelling  occasionally  takes 
place  in  the  breast,  attended  with  a  knotty  and  irregular 
feeling,  when  the  neuralgic  pains  have  existed  a  consider- 
able time  in  that  part,  prickling  and  numbness,  tingling 


PKIXCIPLES   OF  OSTEOPATHY.  153 

and  creeping  sensations  are  often  felt  in  the  upper  extremi- 
ties; and  also  a  sensation  of  cold  water  trickling  over  the 
surface.  On  rubbing  the  hands  over  the  part  affected  a 
soreness  is  frequently  felt,  which  is  described  as  not  merely 
situated  in  the  integuments  but  also  in  the  more  deep  seated 
parts.  In  the  muscular  system  are  observed  most  fre- 
quently a  weakness  of  the  upper  extremities  sometimes 
referred  particularly  to  the  wrists,  tremors  and  unsteadi- 
ness of  the  hands ;  also  cramps  and  spasms  of  various 
degrees  of  intensity.  Occasionally  there  is  an  inability  to 
perform  complete  extension  of  the  elbows,  the  arm  appear- 
ing restrained  by  the  tendon  of  the  biceps ;  pain  and  tight- 
ness being  produced  in  this  part  when  extension  is  at- 
tempted beyond  a  certain  point.  As  far  as  I  have  observed, 
the  pain  and  other  morbid  feelings  in  the  upper  extremities 
and  chest  are  felt  more  frequently  and  more  severely  on 
the  left  than  on  the  right  side. 

"Females  of  sedentary  habits  appear  particularly  sub- 
ject to  these  affections  of  the  upper  extremities,  and  it  is 
not  uncommon  for  them  to  complain  of  being  scarcely  able 
to  feel  the  needle  when  it  is  held  in  their  fingers,  and  that 
their  needles  and  work  frequently  drop  from  their  hands. 

"When  the  upper  dorsal  portion  is  affected,  in  addition 
to  various  morbid  sensations  similar  to  those  in  the  extremi- 
ties, there  is  often  a  fixed  pain  in  some  part  of  the  inter- 
costal muscles,  to  which  the  name  pleurodynia  has  been 
assigned ;  and  when  this  pain  has  existed  a  long  time, 
there  is  tenderness  on  pressing  the  part.  When  the  lower 
dorsal  half  of  the  spinal  marrow  is  the  seat  of  irritation, 
or  subacute  inflammation,  the  pleurodynia,  when  it  exists, 
is  felt  in  the  lower  intercostal  muscles :  frequently  there 
is  also  a  sensation  of  a  cord  tied  round  the  waist :  and 
oppressive  sense  of  tightness  across  the  epigastrium  and 
lower  sternal  region ;  and  soreness  along  the  cartilages  of 
the  lower  ribs  or  in  the  course  of  insertion  of  the  dia- 
phragm. Various  pains,  fixed  and  fugitive,  are  also  felt 
in  the  parietes  of  the  abdomen,  throughout  any  part  of  the 
abdominal  and  lumbar  muscles;  the  pain  is  frequently 


154  PRINCIPLES  OF  OSTEOPATHY. 

fixed  in  some  portion  of  the  rectus  muscle  and  not  infre- 
quently in  the  oblique  muscle  or  transversalis,  a  little  above 
the  crest  of  the  ilium,  particularly  when  the  origin  of  two 
or  three  of  the  lowest  dorsal  nerves  is  diseased. 

"The  affection  of  the  lumbar  and  sacral  portion  of  the 
spinal  cord  often  produces  a  sensation  of  soreness  in  the 
scrotum  and  neighboring  integuments ;  and  the  lower  ex- 
tremities become  the  seat  of  various  morbid  sensations, 
spasms,  tremors,  etc.,  for  the  most  part  resembling  those 
which  have  been  described  as  occurring  in  the  upper  limbs. 
The  patients  also  complain  of  a  sense  of  insecurity  or  in- 
stability in  walking;  their  knees  totter,  and  feel  scarcely 
able  to  support  the  weight  of  the  body. 

"In  some  cases  very  considerable  relief  is  found  from 
recumbency,  the  pain  frequently  being  diminished  as  soon 
as  the  patient  retires  to  bed,  independently  of  any  paroxys- 
mal remission. 

"This  irritation  or  subacute  inflammatory  state  of  the 
spinal  marrow  is  not  necessarily  connected  with  any  de- 
formity of  the  spine,  or  disease  in  the  vertebrae.  It  may 
co-exist  with  these  as  well  as  with  any  other  diseases,  but 
it  so  repeatedly  occurs  without  them  that  they  can  not  be 
regarded  as  dependent  upon  each  other.  Where,  however, 
inflammation  and  ulceration  of  the  vertebrae  or  interverte- 
bral  cartilages  exist,  it  is  probable  they  may  predispose  to, 
and  in  some  instances,  act  as  an  exciting  cause  of  an  in- 
flammatory state  of  the  nervous  structures  which  they  con- 
tain ;  for  we  not  unfrequently  find  inflammatory  affections 
of  the  vertebrae  in  conjunction  with  symptoms  of  irritation 
of  the  spinal  marrow.  But  these  two  affections,  although 
co-existing,  bear  no  regular  relations  to  each  other;  and 
during  the  progress  of  the  vertebral  disease  the  affection 
of  the  nervous  structures  is  subject  to  great  changes  and 
fluctuations.  The  local  remedies  employed  for  arresting 
the  disease  in  the  bone  often  alleviate  the  affection  of  the 
spinal  marrow  at  the  very  commencement  of  the  treat- 
ment, long  before  the  vertebral  disease  is  suspended ;  but 
as  the  neighboring  inflammation  in  the  bones  appears  to 


PRINCIPLES   OF  OSTEOPATHY.  155 

predispose  or  excite  the  nervous  mass  which  they  contain 
to  disease,  relapses  of  the  nervous  affections  are  repeatedly 
occurring  during  the  whole  course  of  the  complaint. 

"The  affections  of  the  spine,  termed  lateral  curvature 
and  excurvation,  appear  to  have  no  necessary  connection 
with  the  disease  which  I  have  been  describing;  and  the  pro- 
portion of  cases  in  which  they  are  found  united  is  so  small 
that  lateral  curvature  can  scarcely  be  considered  even  as 
predisposing  to  this  disease.  The  most  extreme  degrees 
of  deformity  are  frequently  observed  without  any  affection 
of  the  nerves ;  and  when  lateral  curvature  does  occasionally 
co-exist,  local  antirlogistic  treatment  will  often  speedily  re- 
move the  nervous  symptoms  while  the  curvature  remains 
unrelieved.  Hence  there  is  an  impropriety  in  considering 
these  nervous  symptoms  as  a  result  of  the  deformity  and 
in  explaining  them  upon  the  mechanical  principal  of  pres- 
sure and  stretching,  to  which  the  nerves  are  supposed  to 
be  subjected  as  they  issue  from  the  intervertebral  foramina. 
If  the  pressure  and  stretching  produced  by  the  curvature 
were  the  cause  of  the  nervous  symptoms,  they  ought  to 
continue  as  long  as  the  deformity  remains. 

"Treatment. — \Yhen  the  different  neuralgic  symptoms 
which  have  been  enumerated  can  be  traced  to  this  morbid 
state  of  some  portion  of  the  spinal  marrow,  the  treatment 
that  ought  to  be  pursued  is  readily  decided  upon.  Local 
depletion  by  leeches  or  cuping,  and  counter  irritation  by 
blisters  to  the  affected  portion  of  the  spine,  are  the  prin- 
cipal remedies.  A  great  number  of  the  cases  will  frequently 
yield  to  the  single  application  of  any  of  these  means.  Some 
cases  which  have  even  existed  several  months  I  have  seen 
perfectly  relieved  by  the  single  application  of  a  blister  to 
the  spine,  although  the  local  pains  have  been  ineffectually 
treated  by  a  variety  of  remedies  for  a  great  length  of  tune. 
A  repetition  of  the  local  depletion  and  blistering  is,  how- 
ever, often  necessary  after  the  lapse  of  a  few  days,  and 
sometimes  is  required  at  intervals  for  a  considerable  length 
of  time.  In  a  few  very  obstinate  cases  issues  or  setons 
have  been  thought  necessary ;  and  where  the  diseasr-  has 


156  PEINCIPLES   OF  OSTEOPATHY. 

been  very  unyielding,  a  mild  mercurial  course  has  appeared 
beneficial. 

"When  my  attention  was  first  directed  to  this  subject, 
I  considered  recumbency  a  necessary  part  of  the  treatment ; 
it  is,  for  a  moderate  length  of  time,  undoubtedly  beneficial 
and  frequently  very  much  accelerates  recovery,  but  sub- 
sequent observation  has  convinced  me  that  it  is  by  no 
means  essential.  I  have  seen  several  instances  of  the  most 
severe  forms  of  those  complaints  occurring  in  the  poorer 
classes  of  society,  where  continued  recumbency  was  im- 
practicable, which  have,  nevertheless,  yielded  without  diffi- 
culty to  the  other  means  of  the  treatment,  whilst  the  indi- 
viduals were  pursuing  their  laborious  avocations. 

"These  observations,  however,  are  not  intended  to 
apply  to  those  cases  in  which  there  is  actual  disease  of 
the  vertebrae. 

"When  there  exists  a  tendency  to  relapse,  I  have 
thought  it  advantageous  to  continue  the  use  of  some  stim- 
ulating liniment  to  the  spine  for  a  few  weeks  after  the 
other  means  of  treatment  have  been  discontinued.  A  lini- 
ment consisting  of  one  part  spirits  of  turpentine  and  two 
of  olive  oil  is  what  has  generally  been  employed. 

"The  ganglia  of  the  sympathetic  nerves  appear  subject 
to  a  state  of  disease  similar  to  that  which  has  been  de- 
scribed in  the  preceding  chapter,  as  occurring  in  the  spinal 
marrow. 

"As  the  disease  may  be  confined  to  one  part  of  the 
spinal  marrow,  or  may  exist  simultaneously  in  different 
portions,  or  may  even  pervade  its  whole  extent,  so  the 
affection  of  ganglia  may  be  confined  to  one  of  these  nervous 
masses,  may  exist  in  several  which  are  contiguous,  or  in 
ganglia  remote  from  each  other ;  and  as  there  is  reason  to 
believe  the  whole  chain  may  occasionally  be  affected. 

"The  disease  of  the  ganglia  is  seldom  found,  except 
in  conjunction  with  that  of  the  corresponding  portion  of 
the  spinal  marrow,  whereas  the  spinal  marrow  is  often 
affected  without  the  neighboring  ganglia  being  under  the 
influence  of  disease.  Thus  we  frequently  find  symptoms 


PRINCIPLES   OF  OSTEOPATHY.  157 

of  disease  in  a  portion  of  the  spinal  marrow  without  any 
evidence  of  its  existence  in  the  corresponding  ganglia,  fre- 
quently the  symptoms  of  both  combined,  and  occasionally, 
but  rarely,  symptoms  referable  to  the  ganglia  without  the 
spinal  marrow  being  implicated. 

"The  principal  symptoms  resulting  from  irritation  of 
the  ganglia  of  the  sympathetic  are  to  be  found  in  those 
organs  which  derive  their  nerves  from  this  source.  They 
consist  of  perverted  functions  of  these  organs,  and  are 
exemplified  by  a  variety  of  phenomena.  The  involuntary 
muscles,  deriving  their  power  from  the  sympathetic,  have 
their  action  altered  as  is  evinced  by  spasms  and  irregu- 
larity in  their  contractions.  The  heart  is  seized  with  palpi- 
tations, the  large  vessels  with  inordinate  pulsations ;  the 
muscular  fibres  connecting  with  the  bronchial  apparatus 
are  thrown  into  spasms,  constituting  a  genuine  asthma 
independent  of  bronchial  inflammation.  The  muscular 
fibres  of  the  stomach  and  intestines  become  the  seat  of 
spasms  and  various  other  deviations  from  their  natural 
operation.  The  sensibility  of  the  organs,  which  derive 
their  sentient  power  from  the  great  sympathetic,  is 
variously  perverted,  the  nervous  filaments  being  the  seat 
of  pain.  The  heart  and  lungs,  for  instance,  are  subject  to 
morbid  sensations  bearing  great  analogy  to  those  which 
have  been  designated  "tic  douloureaux"  when  occurring 
in  the  spinal  nerves.  The  stomach  and  intestines  are  liable 
to  similar  neuralgia,  to  which  the  names  gastrodynia  and 
enterodynia  have  been  applied.  The  kidneys,  the  bladder, 
and  the  uterus  are  liable  to  the  same  perverted  state  of 
their  sensibility.  The  secretions  also  undergo  alterations, 
products  being  formed,  which  in  health  have  no  existence. 
This  is  exemplified  by  the  enormous  secretions  of  air  which 
sometimes  occur  in  the  stomach.  Large  quantities  of  clear 
transparent  liquid  are  also  secreted  by  this  organ,  consti- 
tuting what  is  called  pyrosis.  The  secretions  of  the  stom- 
ach undergo  variation  in  their  quantities,  rendering  them 
unfit  for  digestive  process.  It  is  probable  that  the  secre- 
tion of  the  liver  also  experiences  some  alteration  in  these 


158  PEINCIPLES  OF  OSTEOPATHY. 

complaints.  The  urine  is  sometimes  influenced,  and  I  am 
inclined  to  suspect  that  some  forms  of  diabetes  partake  of 
neuralgic  character.  Leucorrhoea  is  frequently  a  concom- 
itant of  these  diseases,  and  ceases  on  their  removal ;  but 
I  am  not  prepared  to  say  that  it  is  ever  symptomatic  of 
them.  Irregularities  in  the  catamenia  are  often  observed, 
the  discharge  often  being  generally  in  excess. 

"The  ganglia  most  liable  to  the  disease  are  the  middle 
and  lower  thoracic,  from  which  the  splanchnic  nerves  are 
derived,  giving  rise  to  various  disorders  of  the  stomach 
and  digestive  organs,  which  will  hereafter  be  more  fully 
discussed.  Next  in  frequency  is  the  affection  of  the  cervi- 
cal ganglia,  producing  painful  and  spasmodic  states  of  the 
heart.  The  symptoms  denoting  disease  of  other  ganglia, 
although  occasionally  met  with  are  less  frequent  in  their 
occurrence.  Irritability  of  temper  and  depression  of  spirits 
often  attend  these  complaints,  particularly  the  stomach  is 
the  part  which  suffers. 

"The  disease  of  the  ganglia,  like  that  of  the  spinal 
marrow,  is  not  necessarily  connected  with  disease  of  the 
vertebra  or  distortion  of  the  spine.  It  may  co-exist  with 
these  complaints,  and,  when  it  does  so,  the  symptoms 
proper  to  the  ganglionic  disease  are  often  erroneously  sup- 
posed to  be  produced  by  distortion  or  by  disease  of  the 
vertebrae ;  they  are,  however,  frequently  relieved  by  treat- 
ment, whilst  the  disease  of  the  bones  remains  uninfluenced 
by  it,  and  the  most  extreme  distortion  of  the  spine  or  de- 
struction of  the  vertebrae  from  inflammation  may  exist 
without  there  being  any  symptoms  attributable  to  neural- 
gia of  the  sympathetic  nerves. 

"In  conjunction  with  the  symptoms  denoting  disease 
of  the  ganglia,  tenderness  to  a  greater  or  less  degree  may 
generally  be  found  on  pressing  some  part  of  the  spine,  and 
the  tender  portion  invariably  corresponds  with  the  symp- 
toms ;  or  rather,  the  seat  of  tenderness  is  near  the  part 
occupied  by  the  particular  ganglia  from  which  the  nerves 
of  the  disordered  organ  are  derived ;  for  example,  when 
the  heart  is  affected  the  tenderness  is  found  in  some  of  the 


PEINCIPLES  OF  OSTEOPATHY.  159 

cervical  vertebrae,  and  when  the  stomach  is  the  seat  of  com- 
plaint, it  is  in  some  of  the  middle  or  lower  dorsal  vertebrae. 

"With  respect  to  the  treatment,  I  have  but  little  to  add 
to  what  has  been  said  in  the  preceding  chapter  respecting 
the  treatment  of  irritation  of  the  spinal  marrow.  Leeches, 
cuping,  blisters,  etc.,  to  the  neighborhood  of  the  affected 
ganglia  constitute  the  essential  part." 

Muscular  Contraction. — Following  the  observation  of 
spinal  tenderness  came  the  noting  of  muscular  tension 
accompanying  it.  As  near  as  I  can  determine  from  perus- 
ing medical  literature,  muscular  tension  was  not  recognized 
until  after  the  advent  of  Osteopathy.  Since  the  attention 
of  medical  writers  was  called  to  the  conditions  of  the  spinal 
column  called  "lesions"  there  are  frequent  passages  descrip- 
tive of  these  in  medical  literature.  One  of  the  best  of  these 
references  is  found  in  Boardman  Reed's  work  on  "Diseases 
of  the  Stomach  and  Intestines,"  and  is  as  follows : 

"Dr.  John  P.  Arnold  has  recently  called  attention  to 
a  novel  objective  sign  which  may  be  recognized  upon  pal- 
pation over  the  sensitive  regions  along  side  of  the  spinal 
vertebrae,  and  sometimes  in  such  regions  which  are  not 
sensitive  to  pressure,  though  in  all  cases  he  maintains  that 
the  part  of  the  body  supplied  by  the  vaso  motor  nerve 
fibres  immerging  in  the  corresponding  intervertebral  space 
will  be  found  to  present  some  abnormal  condition.  The 
peculiarity  described  by  him  is,  in  such  cases,  a  somewhat 
doughy,  and  in  chronic  ones,  a  gristly,  tense,  cord-like  feel- 
ing of  the  band  of  longitudinal  muscular  fibres  which  run 
up  and  down  on  either  side  of  the  spine.  This  abnormality 
is  supposed  by  Arnold  to  be  due  to  a  congested  or  infil- 
trated condition  of  the  muscle  while  the  cord  itself  is 
anaemic,  probably  in  chronic  cases.  Hammond  believed  the 
spinal  cord  to  be  anaemic  in  such  cases.  The  findings 
obtained  by  a  careful  palpation  over  the  spine  should  thus 
assist  in  directing  our  attention  to  the  organ  or  part  of  the 
body  which  may  be  suspected  of  being  diseased. 

"You  should  make  it  a  rule  to  examine  carefully  the 
spines  of  all  chronic  invalids  by  pressing  deeply  with  the 


160  PEIXCIPLES  OF   OSTEOPATHY. 

finger  tips  (or  with  the  thumbs,  as  Flint  advised)  close  to 
the  vertebrae  and  then  exert  gentle  traction  in  a  lateral 
direction  outward  from  the  spine  on  either  side.  The 
patient  should  be  lying  upon  his  right  side  while  you 
palpate  along  the  left  side  of  the  vertebrae,  and  should 
then  change  to  his  left  side  in  order  that  you  may  palpate 
upon  the  right  side  of  the  latter  so  that  the  tissues  may  be 
in  the  utmost  condition  of  relaxation  practicable.  In  both 
cases  you  will  find  it  best  to  stand  in  front  of  the  patient 
and  reach  over  his  upper  side  to  make  palpation  along  the 
region  of  the  upper  side  of  the  spinal  column. 

"In  numerous  patients,  especially  those  suffering  from 
digestive  derangements,  you  will  be  likely  while  palpa- 
ting in  the  way  described  to  recognize  in  the  longitudinal 
muscles  running  parallel  and  close  to  the  spine  the  tense, 
cord-like  sensation  above  mentioned.  If,  simultaneously 
with  your  recognition  of  such  a  condition  the  patient  com- 
plains of  sensitiveness  in  the  same  regions,  the  accuracy 
of  your  finding  will  be  at  once  confirmed." 

The  use  of  these  tense  cord-like  muscles  as  diagnostic 
evidences  of  disease  has  been  a  constant  practice  of  Osteo- 
paths from  the  beginning  of  Dr.  Still's  work.  Judging  from 
the  quotation  the  true  significance  of  these  contractions  has 
not  been  apprehended  by  the  medical  "profession  in  general. 

It  is  very  evident  that  a  contracted  muscle  is  shorter 
and  thicker  than  when  relaxed,  also  that  when  contracted  it 
exerts  force  to  draw  its  extremities  together.  The  ends  of 
the  muscle  being  attached  to  bones  forming  portions  of  a 
movable  articulation,  a  change  in  the  relation  of  the  bone 
must  follow.  This  change  is  called  a  subluxation  and  is 
described  more  in  detail  in  the  following  chapter. 

Having  noted  that  sensitiveness  and  muscular  con- 
traction are  well  recognized  conditions  found  along  the 
spinal  column,  the  question  arises,  are  these  merely  objec- 
tive symptoms  of  disease  or  are  they  to  a  large  extent 
causative  factors  in  the  origin  and  maintenance  of  dis- 
eased conditions  of  the  areas  of  peripheral  distribution  of 
spinal  nerves?  Are  they  causes  or  effects? 


PKIXCIPLES  OF  OSTEOPATHY.  161 

They  have  been  noted  almost  exclusively  as  efficient 
causes  of  disease.  Furthermore  osteopathic  therapeutics 
have  been  administered  from  that  standpoint  with  marked 
success.  This  change  in  position  and  size  of  tissues  is 
recognized  as  an  obstruction  to  the  movements  of  fluids, 
and  therefore  is  a  condition  operating  in  the  system  to 
cause  disease. 

Classes  of  Lesions. — Lesions,  according  to  osteopathic 
theory  may  be  of  two  classes,  i.  e.,  first,  change  in  size  of 
tissues;  second,  change  in  position.  Generally  speaking, 
a  change  in  size  is  far  more  difficult  to  overcome  than  a 
change  in  position ;  because  the  former  is  a  result  of  more 
profound  changes.  Tissues  may  increase  in  size  as  the 
result  of  efforts  to  repair  injury,  e.  g.,  the  formation  of 
callous  in  bone,  or  thickening  of  ligaments  following  a 
sprain. 

Cause  of  Lesions. — The  causes  of  lesions  fall  under  two 
general  divisions.  First,  violence ;  second,  failure  to  react 
to  environment. 

In  the  first  division,  all  the  lesions  are  primary  in 
character,  i.  e.,  the  violence  immediately  changes  the  rela- 
tions of  structure,  and  this  change  becomes  an  obstruction 
to  vital  activity  of  the  body  fluids.  If  the  lesion  is  not 
corrected  by  the  recuperative  power  of  the  body  itself  or 
by  outside  efforts,  the  change  in  position  is  very  apt  to 
become  complicated  by  a  change  in  size.  The  injury  re- 
sults in  thickening  of  the  ligaments  or  other  fibrous  tissues. 

The  second  division  of  lesions  is  a  very  large  one. 
These  lesions  develop  as  an  evidence  of  the  failure  of  the 
organism  to  become  perfectly  adapted  to  its  food,  clothing, 
labor  or  general  environment.  They  are,  therefore,  second- 
ary in  character  and  must  be  recognized  as  objective  symp- 
toms of  one  functional  derangement,  while  at  the  same  time 
they  operate  primarily  to  cause  functional  derangement 
elsewhere.  Thus  they  may  be  removed  by  manipulation 
and  cease  to  act  as  an  active  cause  of  functional  change, 
but  will  return  again  so  long  as  environmental  forces  are 
overwhelming. 


162  PE1NCIPLES  OF  OSTEOPATHY. 

The  first  division  or  primary  lesion  may  result  from 
sudden  violence  or  from  a  force  comparatively  weak  but 
long  continued.  In  other  words,  a  lesion  may  be  developed 
immediately  under  great  force  or  slowly  as  the  result  of 
great  fatigue.  An  example  of  a  lesion  developing  under 
fatigue  is  noted  in  the  faulty  positions  assumed  by  the 
body  following  prolonged  effort  or  in  performing  certain 
tasks. 

The  second  division  or  secondary  lesions  may  result 
from  failure  to  react  properly  to  changes  of  temperature. 
The  temperature  of  the  surrounding  air  may  be  the  same 
at  various  times,  but  the  character  of  the  cothing  may 
necessitate  a  greater  effort  at  adaptation.  There  must  be 
suddenness  in  the  change  of  temperature  or  clothing  in 
order  to  produce  the  lesion,  i.  e.,  the  responsiveness  of  the 
tissues  must  be  overtaxed.  The  first  effect  of  failure  of 
adaptation  is  the  contraction  of  muscle  and  accompanying 
sensitiveness.  The  distortion  of  the  bony  structure  is  con- 
sequent on  the  contraction.  Ordinarily,  if  the  shock  is 
not  too  great,  the  adaptive  forces  of  the  organism  will  exert 
sufficient  power  to  correct  the  condition,  but  when  the 
environment  is  not  suitable  the  lesion  may  become  perma- 
nent. Humidity  or  electrical  conditions  of  the  atmosphere 
may  operate  to  produce  these  lesions. 

We  have  noted  that  these  lesions  have  been  discovered 
coincident  with  visceral  disorder.  We  may  therefore  safely 
assume  that  food  which  is  too  difficult  of  digestion,  or  the 
usual  food  taken  during  fatigue,  may  act  chemically  to 
produce  spinal  lesions.  In  this  instance  they  are  certainly 
objective  symptoms  of  visceral  disease,  but  as  stated  before 
they  must  be  primary  causes  of  other  disorders.  To  remove 
such  a  lesion  by  manipulation  is  helpful  to  the  organism, 
but  the  patient  must  know  that  dietetic  indiscretions  or 
eating  when  fatigued  was  the  real  starting  point  of  the 
disease.  Here  is  where  dietetic  and  hygienic  knowledge 
must  be  a  portion  of  the  physician's  therapeutics.  If  the 
pointing  out  of  structural  changes  as  a  result  of  functional 
disturbance  due  to  indiscretions  in  eating  and  ofhcr  appe- 


PEIXCIPLES  OF  OSTEOPATHY.  163 

tites,  will  lead  patients  to  simpler  living,  the  physician  may 
feel  that  he  has  performed  a  duty  more  valuable  to  the 
patient  than  the  removal  of  his  secondary  lesions.  There 
can  be  no  doubt  but  that  the  removal  of  a  primmy  lesion 
due  to  violence  is  absolutely  essential,  but  when  we  main- 
tain that  all  lesions  must  be  removed  before  function  can 
right  itself,  we  become  absurd.  Furthermore,  if  we  con- 
tend that  a  structural  lesion  antedates  ail  functional  dis- 
turbances we  make  of  life  a  series  of  accidents,  instead  of 
a  force  governed  by  fixed  laws. 

The  question  arises  why  does  the  muscular  contraction 
persist  after  the  proper  changes  in  habits  have  been  made? 
This  question  can  not  be  answered  at  present.  Scarcely 
one  of  us  will  voluntarily  make  the  change  in  habits  until 
forced  to  do  so  by  failure  of  the  body  to  respond  to  our 
demands.  Many  things  of  a  sociological  character  are  at 
work  to  compel  people  to  labor  after  fatigue  is  evident, 
to  eat,  sleep,  and  dress  unhygienically.  Viewed  from 
this  standpoint,  the  practice  of  medicine  is  a  problem  in 
sociology. 

The  original  irritation  which  causes  the  tension  prob- 
ably causes  more  or  less  congestion  of  blood.  The  conges- 
tion results  in  over-growth  of  tissue,  which  becomes  a  fixed 
condition  maintaining  the  lesion,  i.  e.,  it  is  a  portion  of 
the  lesion. 

Diagnosis  of  Lesions. — \Ye  have  considered  three 
points  concerning  lesions — hyperaesthesia,  muscular  con- 
traction, and  subluxation.  They  have  been  considered 
in  this  order  merely  on  account  of  historical  reference.  In 
osteopathic  practice,  they  are  reversed.  We  note  first  the 
structure,  then  the  tension  which  accompanies  the  change 
in  structure,  then  the  hyperaesthesia. 

Changes  Due  to  Growth. — It  is  not  uncommon  to 
find  changes  from  the  usual  forms  of  the  bones.  Some- 
times these  changes  may  be  very  deceptive,  but  when 
analyzed  with  reference  to  the  existence  of  functional  dis- 
order in  the  area  of  their  normal  influence  and  the  presence 
of  hyperaesthesia,  they  will  be  recognized  as  morphological 


164  PKINCIPLES  OF  OSTEOPATHY. 

changes  due  to  natural  causes.  Lesions  which  might  have 
been  active  at  a  former  time  are  sometimes  nonactive  on 
account  of  laws  of  accommodation  which  are  always  active 
in  the  body.  If  the  body  has  succeeded  in  recuperating 
from  the  effect  of  these  lesions,  it  is  unwise  to  disturb  them. 
As  an  example  of  an  accommodated  lesion,  we  may  mention 
the  formation  of  a  new  socket  for  the  head  of  the  femur 
following  dislocation. 

There  are  variations  in  development  all  through  the 
body,  and  each  -physician  should  strive  to  become  ac- 
quainted with  them. 

Structure. — The  first  sign  of  a  lesion  is  noted  by  pal- 
pation, i.  e.,  the  change  in  structure  is  felt.  According  to 
what  we  have  just  said,  this  is  not  sufficient  evidence  of 
the  existence  of  an  active  lesion.  It  must  be  accompanied 
by  other  signs.  First,  try  to  eliminate  the  apparent  exist- 
ence of  the  lesion  by  having  the  patient  "assume  different 
positions."  Second,  note  whether  the  bony  land  marks  in 
that  area  vary  from  the  normal.  Third,  note  whether  the 
lesion  causes  the  patient  to  assume  any  special  attitude. 
Fourth,  test  the  amplitude  of  movement  in  the  articulation 
to  determine  the  changes  in  its  extent.  If  there  is  perfect 
flexibility  it  is  scarcely  probable  that  a  lesion  exists,  for 
an  active  lesion  is  quite  inconceivable  without  tension. 
Fifth,  feel  of  the  soft  parts  of  the  joints,  muscles  and  con- 
nective tissues.  Note  any  swelling  or  change  in  tempera- 
ture. Sixth,  inspect  the  surface  as  to  color  and  texture. 
Seventh,  test  sensibility  by  pressure  as  has  been  described 
heretofore. 

Ordinarily  an  examination  of  the  body  for  lesions  con- 
sists in  comprehensive  palpation,  which  notes  synchron- 
ously the  existence  of  positional  change,  tension,  tempera- 
ture, swelling,  and  sensitiveness.  The  existence  of  tension 
is  sufficient  evidence  of  decrease  of  flexibility. 

Correction  of  Lesion. — When  violence  is  the  cause 
of  the  lesion,  it  is  necessary  to  correct  structure  directly. 
When  the  osseous  lesion  is  the  result  of  muscular  tension 
due  to  reflex  stimulation,  methods  differ  according  to  the 


PRINCIPLES  OF  OSTEOPATHY.  165 

view  point  of  the  physician.  Some  manipulate  for  direct 
reduction,  others  relax  muscles,  and  thus  remove  the  cause 
of  the  osseous  lesion.  The  really  comprehensive  plan  should 
take  into  account  the  cause  of  the  tension  which  occasions 
the  osseous  lesion.  Having  done  this,  the  physician  may 
manipulate  the  lesion  to  secure  direct  reduction  with  the 
feeling  that  the  problem  has  been  undertaken  wisely. 


CHAPTER    IX. 


SUBLUXATIONS. 

The  word  subluxation  belongs  most  decidedly  to  osteo- 
pathic  literature.  No  other  system  of  therapeutics  has  taken 
any  special  notice  of  the  effect  of  minor  accidents  on  the  os- 
seous and  muscular  structure  of  the  body.  It  may  be  said 
that  the  seed  from  which  the  osteopathic  system  of  therapeu- 
tics grew  had  for  its  germ  cell  a  subluxation. 

Dr.  Still  tells  us  of  his  earnest  thought  and  study  of  the 
skeleton  of  the  human  body.  His  mechanical  brain  could  con- 
ceive of  mechanical  disorders  in  the  body  which  must  be 
treated  mechanically  in  order  to  be  corrected.  Study  and  ex- 
perience combined  to  fix  this  idea  more  firmly  and  vividly 
in  his  brain.  We  can  now  see  the  great  and  lasting  value  of 
his  basic  idea  that  perfect  structure  is  requisite  for  perfect 
function ;  that  there  is  no  unused  space  in  the  body,  hence  a 
bone  out  of  place  must  be  occupying  some  other  tissue's  place ; 
that  impingement  of  bone  or  other  structural  tissue  on  blood 
vessels  and  nerves  results  in  perversion  of  the  normal  function 
of  these  obstructed  media  of  exchange  and  communication. 

Definition. — The  word  subluxation  was  so  new  to  the 
general  medical  profession  that  much  ridicule  was  heaped  upon 
the  osteopaths  because  they  advocated  such  a  ridiculous  theory 
as  that  "all  diseases  are  caused  by  dislocation  of  bone."  We 


166  PEINCIPLES   OF   OSTEOPATHY. 

are  not  so  sure  but  that  this  ridicule  was  to  a  large  extent  well 
merited  by  the  osteopaths.  The  loose  way  in  which  the  words 
luxation,  dislocation  and  subluxation  are  used  in  some  of  our 
literature  shows  that  they  do  not  always  cover  a  definite  idea 
in  the  mind  of  the  writer.  They  can  not  be  used  interchange- 
ably. The  word  subluxation  should  be  used  to  denote  a  def- 
inite pathological  condition.  Subluxation  is  defined  as  a  par- 
tial dislocation  in  which  the  normal  relations  of  the  articu- 
lating surfaces  are  but  slightly  changed. 

Da  Costa  describes  subluxation  of  the  shoulder,  also  of 
the  head  of  the  radius.  For  the  latter  condition  he  has  col- 
lected eight  different  explanations.  We  have  not  been  able 
to  find  the  term  used  in  reference  to  any  other  articulations. 
The  osteopath  uses  the  term  to  define  certain  inequalities  in 
the  arrangement  of  vertebrae  and  ribs.  Perhaps  we  hear  the 
term  used  in  connection  with  the  atlas  more  than  with  any 
other  bone. 

Diagnosis. — Subluxations  allow  considerable  move- 
ment in  the  articulation,  but  to  the  trained  hand  there  are  evi- 
dences of  malposition.  Pain  is  developed  when  the  complete 
normal  movement  is  attempted  by  the  operator.  Digital  pres- 
sure around  the  joint  causes  deep  pain.  There  is  usually  a 
history  of  accident,  exposure  or  visceral  disorder. 

Primary  or  Secondary  Lesions. — From  experience  we 
know  the  frequency  of  very  evident  malpositions  of  vertebrae, 
commonly  spoken  of  as  subluxations,  and  as  being  true  or  pri- 
mary lesions  causing  disordered  function  in  the  area  of  per- 
ipheral distribution  of  the  nerves  from  that  segment  of  the 
spinal  cord. 

Analysis. — in  order  to  get  at  a  true  understanding  of 
what  subluxation  is  we  must  make  a  careful  study  of  the  struc- 
tures which  form  a  joint  and  their  vital  manifestations. 

The  bones  of  the  skeleton  are  bound  together  by  liga- 
ments and  muscles.  The  opposing  surfaces  of  bones  forming 
movable  joints  are  covered  with  cartilage.  The  muscles  exe- 
cute and  the  ligaments  or  soft  parts  around  a  joint  limit  the 
motions  of  the  articulation.  All  moveable  articulations  have 
their  bony  parts  maintained  in  their  normal  relations  either 


PRINCIPLES  OF  OSTEOPATHY.  167 

by  the  form  of  the  bones  and  cartilages  attached  to  them  or 
by  the  equal  tension  of  all  the  controlling  muscles.  Enarthro- 
dial  joints  have  freest  movements  and  yet  are  the  least  de- 
pendent on  muscles  for  retention  of  their  normal  position. 
Air  pressure  and  the  form  of  the  bones  are  responsible  for 
the  integrity  of  these  joints.  These  joints  are  less  frequently 
subluxated  than  those  possessing  more  limited  motion.  Ar- 
throdial  joints  depend  upon  the  equal  tension  of  their  gov- 
erning muscles  to  keep  the  opposed  surfaces  in  their,  proper 
relations.  Co-ordination  of  the  muscular  tension  is  usually 
so  perfect  that  the  joint  surfaces  are  perfectly  opposed  to 
each  other.  The  disturbance  of  this  nicely  balanced  muscular 
tension  results  in  the  drawing  of  one  or  both  bony  surfaces 
away  from  their  true  relations ;  not  entirely,  but  sufficiently 
to  make  it  possible  for  the  physician's  fingers  to  note  the 
change. 

Occipito-atlantal  Articulation. — The;  atlas  is  placed  not 
only  first  in  the  vertebral  column,  but  also  first  in  importance 
to  the  osteopath  on  account  of  the  great  possibilities  for  slight 
displacement  between  it  and  the  occiput.  All  the  conditions 
are  present  which  make  a  very  moveable  joint,  and  close  at 
hand  are  important  nerves  and  blood  vessels  whose  slightest 
maladjustment  causes  instant  disturbance  at  the  very  foun- 
tains of  life. 

No  physical  examination  is  considered  complete  without 
noting  accurately  the  position  of  the  atlas.  There  being  no 
spinous  process,  all  reckoning  must  be  made  from  the  trans- 
verse processes. 

According  to  Gray's  Anatomy:  "The  movements  per- 
mitted in  this  joint  are  flexion  and  extension,  which  give  rise 
to  the  ordinary  forward  and  backward  nodding  of  the  head, 
besides  slight  lateral  motion  to  one  or  the  other  side.  *  * 
*  *  The  Recti  Laterales  are  mainly  concerned  in  the  slight 
lateral  movement.  According  to  Cruveilhier  there  is  a  slight 
motion  of  rotation  in  the  joint." 

According  to  Gerrish :  *  *  *  "Some  lateral  gliding 
is  also  allowed,  by  which  the  outer  edge  of  the  condyle  on  the 
one  side  is  depressed,  and  on  the  other  is  elevated  in  relation 


168  PEINCIPLES   OF  OSTEOPATHY. 

to  its  socket.  Or  the  movement  may  be  obliquely  lateral,  one 
condyle  advancing  slightly  at  the  same  time  that  it  is  de- 
pressed toward  the  median  line,  while  the  opposite  condyle 
takes  the  reverse  position.  This  is  the  position  of  greatest 
stability,  and  is  assumed  in  the  most  easy  and  natural  atti- 
tudes. Lateral  movements  are  restrained  by  the  check  liga- 
ments and  the  lateral  parts  of  the  capsules.  No  true  rotation 
is  allowed." 

The  capsular  ligaments  are  very  loose,  hence  the  strength 
of  the  joint  lies  in  the  anterior,  posterior  and  lateral  ligaments. 
There  is  no  cartilaginous  disk  between  the  atlas  and  occiput, 
hence  motion  is  limited  only  by  the  ligaments  named. 

If  one  should  judge  of  the  prevalence  of  dislocations  of 
the  atlas  by  the  number  of  times  such  a  condition  is  mentioned 
in  osteopathic  literature  we  would  draw  the  conclusion  that 
every  one's  atlas  is  dislocated.  The  term  dislocation  is  a 
strong  one,  and  ought  not  be  used  in  connection  with  the  atlas. 
Its  dislocation  would  cause  death  instantly.  Subluxation  is 
the  proper  term  to  use.  Subluxations  can  be  readily  diag- 
nosed; the  fact  that  they  exist  can  not  be  doubted;  all  posi- 
tions between  the  normal  articulation  and  complete  disloca- 
tion are  possible.  The  complete  dislocation  of  this  bone  from 
the  occiput  means  death;  intermediate  positions,  subluxations, 
mean  both  irritation  of  nerves  direct,  and  both  direct  and  indi- 
rect disturbances  of  circulation ;  direct  disturbance  by  pressure 
exerted  on  arteries  and  veins,  indirect  disturbance  by  excitation 
of  vaso  motor  nerves. 

The  Causes  of  Subluxation. — It  is  difficult  to  account 
for  these  subluxations  of  the  atlas  without  bringing  in  the 
contraction  of  muscles.  This  seems  to  me  to  be  the  most 
prevalent  cause  of  misplacement  of  the  atlas.  Even  though 
we  recognize  the  numberless  jars,  twists  and  strains  of  this 
articulation,  still  the  resultant  bad  effec  •»  are  maintained  by 
the  unequal  contraction  of  opposing  groups  of  muscles  which 
is  brought  on  by  these  accidents.  Take,  for  instance,  the  va- 
rious twists  of  the  atlas  found  by  osteopathic  methods  of 
physical  diagnosis.  Gray  says :  "The  Recti  Laterales  are 
mainly  concerned  in  the  slight  lateral  movements."  This  is 


PRINCIPLES  OF  OSTEOPATHY.  169 

the  movement  concerned  in  a  lateral  subluxation.  The  posi- 
tion in  which  we  usually  find  the  atlas  is  an  oblique  one,  hav- 
ing- the  right  transverse  process  hugging  the  angle  of  the 
jaw  while  the  left  is  too  close  to  the  mastoid  process. 
Gerrish  describes  this  position  as  the  "obliquely  lateral,"  a 
normal  movement.  We  also  consider  it  normal  if  it  possesses 
the  ability  to  slip  back  into  a  position  having  similar  rela- 
tions on  both  sides.  It  is  a  subluxation  when  it  can  not  get 
out  of  that  position  without  assistance.  If  there  is  free  move- 
ment in  the  occipito-atlantal  articulation,  every  change  of  the 
position  of  the  head  will  change  the  relations  in  this  joint. 
Our  bodies  are  constructed  so  that  when  the  bones  form- 
ing a  joint  are  moved  to  their  fullest  extent  pressure 
is  usually  exerted  on  soft  tissues  around  the  joint.  This  is 
normal,  but  when  these  normal  relations  are  retained  too  long 
and  the  bones  do  not  resume  their  easy  resting  position  the 
condition  becomes  abnormal;  it  is  then  a  subluxated  joint. 

There  is  no  articulation  in  the  body  whose  bony  parts 
are  abnormally  related  when  the  extreme  movement  in  the 
joint  is  made.  We  will  except  the  sacro-iliac  articulation,  be- 
cause it  is  not  considered  a  moveable  joint.  The  subluxa- 
tion consists  in  the  relation  of  the  bony  surfaces  in  a  posi- 
tion other  than  that  which  they  should  hold  during  relaxa- 
tion or  equal  tension  of  all  the  muscles.  The  normal  posi- 
tion of  the  transverse  processes  of  the  atlas  is  pictured  in 
Fig  31.  The  subluxations  are  pictured  in  Fig  32. 

The  normal  relations  of  the  atlas  are  illustrated  by  photo- 
graphs of  the  skull  and  first  cervical  vertebra  in  Fig.  33.  Fig 
34  shows  an  oblique  side  view.  In  Fig.  35  the  atlas  is  slightly 
twisted,  so  that  the  right  transverse  process  is  posterior.  This 
rear  view  shows  the  distance  between  the  left  mastoid  and 
left  transverse  process  increased.  The  right  transverse  pro- 
cess is  prominent.  The  same  relations  viewed  from  below  are 
shown  in  Fig.  36.  The  right  transverse  process  is  slightly 
posterior  to  the  mastoid. 

Figs.  37  and  38  show  side  and  lateral  views  of  a  twisted 
atlas.  In  preparing  these  bones  for  photographing,  it  has 
been  borne  in  mind  that  the  articulating  surfaces  must  be 


170 


PRINCIPLES  OF  OSTEOPATHY. 


Fig.  31. — Normal  surface  marking  of  the  transverse  process  of  the  Atlas. 


PEINCIPLES   OF  OSTEOPATHY. 


171 


kept  in  close  apposition.     The  relations  illustrated  are  normal 
to  the  articulation,  but  abnormal  when  retained  in  these  posi- 
after  relaxation  of  opposing  muscles. 
If,   as   Cruveilhier    says,    there    is    a    slight   rotation   in 


Fig.  32. — Abnormal  surface  markings  of  the  transverse  process  of  the  Atlas. 

this  joint — and  osteopathic  practice  proves  Cruveilhier's  state- 
ment true — ,then  what  muscle  could  by  its  persistent  contrac- 
tion cause  this  rotation  to  be  maintained?  The  Rectus  Capi- 
tis  Anticus  Minor  is  so  placed  as  to  cause  this  movement.  It 


172  PRINCIPLES  OF  OSTEOPATHY. 


Fig-    33- — Normal    relations    between    the    Atlas    and    Occipital  bone. 


Fig-     34- — Normal     relations    between    the    Atlas    and   Occipital  bone. 


PEIXCIPLES   OF   OSTEOPATHY. 


173 


arises  from  the  anterior  surface  of  the  lateral  mass  and  root 
of  transverse  process  of  the  atlas  and  passes  obliquely  upward 
and  inward.  It  is  inserted  into  the  basilar  process  of  the  oc- 
cipital bone.  This  muscle  has  as  its  external  relation  the  supe- 
rior cervical  ganglion  of  the  sympathetic,  and  as  a  contracted 
muscle  is  thicker  than  an  uncontracted  one,  pressure  may  be 
exerted  on  this  ganglion  which  may  also  be  irritated  by  the 
transverse  process  of  the  atlas  being  pulled  toward  it,  thereby 
lessening  its  normal  space  in  more  than  one  direction. 


P'S-    35- — Right    transverse   process    of   the  Atlas  too  far  posterior. 

The  reflexes  originated  by  this  irritation  of  the  superior 
cervical  ganglion  or  its  connections  may  initiate  changes  in 
the  caliber  of  the  blood  vessels  of  the  brain,  eyes  or  any  other 
circulatory  area  under  control  of  the  ganglion. 

The  influence  exerted  directly  on  circulation  by  the  sub- 
luxation  of  the  atlas  is  probably  most  active  where  the  verte- 
bral arteries  pass  through  the  foramena  in  the  transverse 
processes.  It  might  be  argued  against  this  view  that  nature 
has  not  failed  to  provide  a  certain  amount  of  elasticity  in  the 
artery  and  surrounding  structures  to  meet  just  such  a  condi- 
tion. Nature  has  certainly  done  this,  but  not  with  the  idea 


174  PRINCIPLES  OF  OSTEOPATHY. 

in  view  that  any  such  exaggerated  condition  is  to  be  main- 
tained for  any  great  length  of  time. 

Subluxations  of  the  atlas  are  found  in  connection  with 
a  great  number  of  disturbed  areas,  but  the  pathological  con- 
dition in  each  is  the  same.  For  instance,  there  is  no  differ- 
ence between  a  hyperaemia  in  the  nasal,  pharyngeal  or  laryn- 
geal  mucosa  and  a  congestion  of  the  retina,  except  in  loca- 
tion. We  must  not  view  retinitis  as  a  distinct  disease  from 
laryngitis.  If  we  should  do  so,  we  fix  our  attention  on  symp- 


Fig.    36. — Right   transverse   process   of   the  Atlas  too  far  posterior. 

toms  and  see  a  picture  which  conceals  causes.  When  the 
superior  cervical  ganglion  has  its  function  of  vaso-constric- 
tion  inhibited  by  continued  irritation,  the  work  of  maintain- 
ing vascular  tone  is  passed  along  to  peripherally  placed  gan- 
glia. If  the  eyes  are  strained  by  over  work,  the  resistance 
of  their  nerves  is  decreased.  This,  added  to  the  weakened 
vaso-constrictor  action  of  the  superior  cervical  ganglion,  al- 
lows congestion,  a  retinitis.  Wearing  high  collars  weakens 
the  resistance  of  nerve  endings  in  the  skin  of  the  neck.  This, 
added  to  low  power  in  the  ganglionic  station,  leads  to  con- 
gestion in  the  pharynx  or  larynx.  Treatment  must  be  ap- 
plied to  the  structures  around  the  ganglion,  and  peripheral 


PRINCIPLES   OF   OSTEOPATHY. 


175 


nerve  power  increased  by  gradually  exposing  the  skin  to  the 
atmosphere. 

The  Atlas  and  Axis. — The  articulation  between  the  at- 
las and  axis  is  the  most  intricate  in  the  whole  spinal  column, 
consisting  of  four  distinct  joints.  Rotation  takes  place  be- 
tween these  bones,  but  this  motion  is  limited  by  the  check 
ligaments.  Dislocation  of  the  odontoid  process  causes  instant 
death  by  pressure  on  the  lower  part  of  the  medulla  oblongata. 

The  articulations  between  the  articular  processes  of  these 


F'g.     37. — Twisted    Atlas-rotation. 

bones  are  arthrodial.  The  articulation  between  the  odontoid 
process  of  the  axis  and  anterior  arch  of  the  atlas  holds  the 
bones  firmly  together.  Most  of  the  rotation  in  the  cervical 
region  is  in  this  joint.  Although  there  is  so  much  movement 
allowed  by  these  articulations  we  seldom  find  the  axis  sub- 
luxated. 

Unequal  Development. — Deviation  of  the  spine  of  the 
axis  from  the  median  line  is  a  frequent  condition,  but  in  the 
majority  of  cases  is  its  normal  relation  on  account  of  uneven 
development. 

Caries. — Hilton  describes  cases  of  disease  of  the  artic- 


I76 


PRINCIPLES  OF   OSTEOPATHY. 


ulation  between  the  atlas  and  axis,  showing  how  destruction 
of  the  transverse  ligaments  allows  the  head  to  tip  forward, 
thereby  causing  the  odontoid  process  to  impale  the  medulla. 

We  may  safely  say  that  dislocation  of  the  atlo-axial  artic- 
ulations is  probably  the  rarest  condition  we  will  ever  meet. 
Various  degrees  of  rotation  may  be  met  with  which  are  in 
the  nature  of  subluxations  due  to  muscular  contractions. 

Spontaneous  Reduction. — Since  the  above  paragraph 
was  written,  an  article  in  the  Medical  Record,  March  third, 


Fig.    38. — Twisted    Atlas-rotation. 


1900,  has  come  under  my  observation.  The  article  is  entitled, 
"Spinal  Fracture — Paraplegia."  The  author,  Dr.  Robert 
Abbe,  exhibits  a  radiograph  illustrating  a  case  of  dislocation 
of  the  neck.  The  dislocation  is  between  the  articular  pro- 
cesses of  the  atlas  and  axis.  The  most  interesting  feature 
of  the  case  is  the  spontaneous  reduction  of  the  dislocation 
while  the  patient  was  asleep.  The  author  thinks  that  the  relax- 
ation of  sleep  and  the  restlessness  of  the  patient  combined  to 
reduce  it. 


PEIXCIPLES   OF  OSTEOPATHY.  177 

Cervical  Vertebrae. — The  remaining  cervical  vertebrae 
are  occasionally  forced  from  their  proper  relations  by  vio- 
lence. Quite  a  number  of  cases  are  on  record  which  show 
how  great  the  disturbance  is  in  such  conditions.  Those  cases 
recorded  in  medical  literature  are  complete  dislocations,  and 
hence  can  not  be  classed  with  subluxations  such  as  are  met 
with  in  osteopathic  practice.  In  order  for  complete  disloca- 
tion to  take  place,  i.  e.,  so  that  the  articular  processes  are  both 
locked,  the  intervertebral  disks  would  have  to  be  torn  and 
would  bring  great  pressure  on  the  cord. 

All  grades  of  subluxation  are  found  between  cervical  ver- 
tebrae.  Where  the  violence  has  not  been  sufficient  to  cause 
locking  of  the  articular  processes,  it  has  exaggerated  the  nor- 
mal movement  sufficiently  to  injure  the  ligaments  or  muscles, 
which  therefore  maintain  the  subluxated  position. 

We  can  not  estimate  the  extent  of  the  systemic  effects 
of  a  lesion  in  the  spine.  What  might  appear  to  us  to  be  a 
very  slight  lesion,  might  be  the  cause  of  a  very  profound  ner- 
vous disorder.  The  position  of  the  lesion  is  the  chief  means 
of  estimating  results. 

To  illustrate  this  point,  we  may  mention  the  case  of  Mr. 
Norton  Russell.  A  lesion  of  the  sixth  cervical  vertebra  was 
found.  The  vertebra  was  slightly  twisted.  Mr.  Russell  had 
not  slept  during  one  hundred  nights  and  days  without  the 
use  of  sulphonol  or  morphine.  The  first  osteopathic  treat- 
ment applied  to  the  sixth  cervical  vertebra  made  it  difficult 
for  him  to  keep  awake  until  he  reached  his  home,  and  then 
he  fell  into  a  profound  sleep.  There  was  a  history  of  severe 
accident.  Muscular  contraction  was  very  evident. 

Fig  39  illustrates  the  appearance  of  the  posterior  surfaces 
of  the  cervical  vertebrae,  second  to  the  seventh,  when  all  the 
vertebrae  are  in  normal  position,  i.  e.,  articular  surfaces  evenly 
opposed  to  each  other.  The  changing  character  of  the  spinous 
processes  is  readily  noted.  Nearly  all  of  these  processes  are 
unevenly  developed,  showing  that  palpation  of  these  prom- 
inent points  can  not  help  being  unsatisfactory.  The  tubercles 
on  the  back  and  outer  surfaces  of  the  inferior  articular  pro- 
cesses present  a  much  more  uniform  development  and  they 


178  PRINCIPLES  OF  OSTEOPATHY. 

can  be  easily  palpated  after  one  has  become  accustomed  to 
the  feel  of  the  cervical  muscles. 

Fig  40  shows  the  third  cervical  subluxated  to  the  right. 
The  tubercle  on  the  left  inferior  articular  process  is  made 
more  prominent.  The  muscles  over  this  point  will  be  found 
contracted. 


F'S-    39- — Normal    relations 
of  the  cervical  vertebrae. 


Fig.  40. — Third  cervical 
vertebra  subluxated  to 
the  right.  The  superior 
articular  process  of  the 
fourth  cervical  is  vis- 
ible. 


Dorsal  Vertebrae. — When  the  spines  of  the  dorsal  ver- 
tebrae are  palpated,  the  trained  fingers  may  find  individual 
spines  which  are  not  in  line  with  those  above  and  below,  or 
that  the  spacings  between  the  spines  is  not  equal.  These  de- 
viations from  the  normal  are  indicative  of  changed  relations 
between  the  vertebrae. 

The  normal  movements  in  the  dorsal  region  are  flexion, 
extension  and  rotation.  The  lesions  in  this  region  correspond 
with  these  movements. 

False  Lesions. — We  must  guard  against  being  misled 
by  the  deviations  which  we  find,  especially  lateral  ones.  Fig. 
41  illustrates  a  decided  lateral  inclination  of  the  third  dorsal 
spinous  process.  Such  a  deflection  from  the  median  line  would 
be  noted  by  the  unskilled  touch  of  a  layman.  This  deflection 


PKINCIPLES  OF  OSTEOPATHY.  179 

has  no  diagnostic  significance,  unless  there  is  pronounced 
sensitiveness  around  it,  and  then  it  is  the  hyperaesthesia  and 
not  the  osseous  formation  that  must  be  noted.  A  very  skill- 
ful osteopathic  diagnostician  might  be  misled  by  this 
lesion.  There  does  not  appear  to  be  any  way  to  protect  against 
a  wrong  interpretation  in  a  case  like  this  except  the  experi- 
ence of  the  physician  in  weighing  all  the  evidence. 


Fig.  41. — Abnormal  development  of  the  spinous  process  of  the  third  dorsal  vertebra. 

A  False  Lesion. 


Lateral  Subluxation. — Fig.  42  illustrates  a  genuine  lat- 
eral subluxation  of  a  dorsal  vertebra.  The  arrangement  of 
the  Rotatores  Spinae  accounts  for  such  a  lesion  as  this.  They 
arise  from  the  upper  surfaces  of  the  transverse  processes  and 
insert  into  the  laminae  above.  The  subluxated  vertebra  in 
this  group  is  the  fifth.  The  digitation  of  the  Rotatores  Spinae 
between  the  right  transverse  process  and  lamina  of  the  sev- 
enth must  contract  in  order  to  produce  this  condition.  This 
digitation  may  respond  to  a  severe  visceral  reflex  and  cause 
a  subluxation  of  this  character.  Direct  violence  may  cause 
it,  also  a  cutaneous  reflex  iniated  by  temperature  change  in 
the  atmosphere. 

Muscular  Contraction. — Muscles  contract  as  a  result 
of  excessive  straining  or  wrenching,  or  exposure  to  cold  and 
of  reflex  irritation.  If  opposing  muscles  under  all  condi- 


i8o  PEINCIPLES  OF  OSTEOPATHY. 

tions  of  temperature,  mechanical  and  reflex  irritation  would 
continue  to  exert  equal  influence  on  a  joint,  then  nothing  but 
a  complete  dislocation  would  be  possible.  A  moveable  joint 
is  enclosed  in  a  synovial  membrane  which  facilitates  the  rap- 
id return  to  a  normal  position.  All  the  mechanical  conditions 
in  and  around  a  joint  are  conducive  to  the  quick  return  to 
normal.  It  is  the  vital  and  not  the  mechanical  principle 
which  keeps  up  a  condition  of  maladjustment.  No  inter- 


Fig.  42. — Lateral  subluxation  of  a  dorsal  vertebra. 

mediate  position  is  possible,  there  being  no  unevenness  of 
surface  to  become  locked,  unless  we  take  into  consideration 
the  vital  activity  as  manifested  in  a  contracted  muscle. 

Comparison  of  Effects  of  Muscular  Contraction. — J.  E. 
Stuart,  D.  O.,  has  made  an  apt  comparison  between  the  pull 
of  the  muscles  of  the  back  on  the  individual  vertebrae  and 
the  well  recognized  insufficiencies  of  the  ocular  muscles.  All 
physicians  recognize  the  serious  effects  of  long  continued  in- 
sufficiency of  an  ocular  muscle,  but  few,  indeed,  have  given 
any  thought  to  the  possibility  of  a  similar  condition  affect- 
ing structures  less  moveable  or  less  sensitive  than  the  eye  ball. 
The  relation  of  a  vertebra  with  its  fellows  is  of  great  im- 
portance to  the  delicate  nervous  tissue  which  it  surrounds. 
It  is  not  necessary  for  a  vertebra  to  press  upon  the  spinal 
cord  or  nerve  fibers  coming  from  or  going  to  it  in  order  to 
produce  irritation.  There  is  a  nerve  strain  in  connection  with 
these  lesions  which  is  not  the  result  of  direct  pressure,  but  of 


PRINCIPLES   OF  OSTEOPATHY. 


181 


the  efforts  of  the  central  nervous  system  to  balance  and  co- 
ordinate the  contraction  of  the  muscles  pulling  on  the  vertebra. 
It  is  not  necessary  for  divergent  or  convergent  squint  to  be 
so  marked  that  the  expression  of  the  eyes  is  instantly  noted 
by  all  observers  before  any  symptoms  of  eye  strain  are  felt 
by  the  patient.  Neither  is  it  necessary  for  a  vertebra  to  be 
dislocated  in  order  to  create  a  disturbance.  It  is  conceivable 
that  a  completely  dislocated  vertebra  might,  after  a  time,  cause 
as  little  irritation  as  an  eyeball  which  is  so  divergent  that  no 
effort  is  made  to  use  binocular  vision.  The  body  becomes 
accommodated  to  the  change. 


Fig.  43. — Flexion  in  the 
dorsal  region  showing 
spinous  processes  sepa- 
rated and  superior  ar- 
ticular processes  par- 
tially uncovered. 


Fig.    44. — Lateral   view    of   same 
condition  as  Fig.  43. 


Separation  of  Spinous  Processes. — Figs.  43  and  44  give 
two  views  of  the  fifth,  sixth  and  seventh  vertebrae,  illustrat- 
ing the  separation  of  the  spines  as  in  extreme  flexion.  Note 
that  the  superior  articular  facets  are  uncovered  by  the  move- 
ment. The  vertebrae  assume  this  position  in  kyphosis.  We 
frequently  find  that  there  is  a  gap  between  two  spines  while 
the  spacing  above  and  below  is  quite  even.  Either  the  space 
directly  above  or  that  below  this  gap  is  lessened.  Fig.  45 
shows  the  spines  of  the  fifth,  sixth  and  seventh  dorsal  ver- 
tebrae in  the  position  of  extreme  extension.  The  spines  crowd 
hard  upon  each  other.  These  illustrations  all  show  normal 


182 


PRINCIPLES  OF  OSTEOPATHY. 


positions,  but  they  are  the  ones  which  our  fingers  discover 
as  lesions  of  the  vertebrae. 

Approximation  of  Spinous  Processes. — When  two 
spines  are  closely  approximated,  as  in  Fig.  45,  there  is  nec- 
essarily a  widening  of  the  next  space  above  or  below,  de- 
pending upon  which  vertebra  is  affected.  The  contracted 
space  will  usually  be  sensitive  to  digital  pressure.  There  is  a 
contractured  condition  of  the  muscles  causing  this  extreme 
movement  of  extension.  This  contracture  disturbs  the 
rhythm  of  nerve  impulses  from  that  section  of  the  spinal 
cord  in  closest  relation  with  the  disturbed  vertebra.  There 
is  a  lack  of  co-ordination  of  movement  in  the  affected  joints. 


Fig.   45.  —  Extension   in   the   dorsal   region  showing  approxima- 
tion  of  the   spinous   processes. 


several  vertebrae  are  tightly  bound  together,  a 
straight,  nonflexible  spinal  column  is  the  result.  The  mus- 
cles are  tightly  contracted  and  more  or  less  sensitive  to 
digital  pressure. 

Subluxations  —  Primary.  —  These  conditions  as  here  il- 
lustrated are  what  osteopaths  usually  designate  as  spinal  sub- 
luxations  which  are  causative  factors  in  disease.  They  are 
sources  of  irritation  to  the  spinal  nerves  in  direct  central  rela- 
lation  with  them,  and  these  nerves  convey  disturbed  or 
arythmical  impulses  to  the  viscera  and  blood  vessels,  thus 
causing  the  various  perversions  of  function  which  are  recog- 
nized as  symptoms  of  disease. 


PRINCIPLES  OF  OSTEOPATHY. 


183 


Subluxations — Secondary. — These  lesions  must  also  be 
recognized  as  structural  changes  resulting  from  excessive  irri- 
tation to  the  peripheral  end  of  sensory  nerves,  either  those 
ending  in  skin  and  subject  to  the  temperature  changes,  or 
those  ending  in  the  visceral  mucosa  and  subject  to  irritation 
from  the  presence  of  food  of  an  indigestible  character,  prod- 
ucts of  fermentation,  etc.  We  must  recognize  the  fact  that 
sensory  nerves  are  subject  to  excessive  stimulation  in  cases 
of  gluttony  or  masturbation.  Both  of  these  bad  habits  may 
result  from  the  stimulation  of  a  spinal  lesion,  but  experience 


Fig.  46. — Posterior  view  of  five 
lower  dorsal  vertebrae,  nor- 
mal relations. 


Fig.  47. — Side  view  of  five  lower 
dorsal  vertebrae,  normal  rela- 
tions. 


with  humanity  teaches  the  physician  that  mankind  in  general 
delights  in  gratifying  the  senses.  We  do  not  wish  to  place 
spinal  lesions  at  the  bottom  of  man's  moral  weaknesses. 

Limited  Area  for  Lateral  Subluxations. — Lateral  sub- 
luxations  may  exist  as  low  as  the  tenth  dorsal  spine.  The 
articular  processes  of  the  eleventh  and  twelfth  dorsal  verte- 
brae take  on  the  character  of  the  lumbar,  hence  rotation  is 
practically  impossible.  There  is  a  digitation  of  the  Rotatores 
Spinae  between  the  eleventh  and  twelfth  dorsal  vertebrae. 


184  PRINCIPLES  OF  OSTEOPATHY. 

Characteristics  of  the  Eighth,  Ninth,  Tenth,  Eleventh 
and  Twelfth  Dorsal  Vertebrae. — Figs.  46  and  47  give  a  pos- 
terior and  lateral  view  of  the  five  lower  dorsal  vertebrae.  The 
changing  characteristics  of  the  spinous  processes  of  these  ver- 
tebrae should  be  carefully  noted,  so  that  the  student  may  not 
be  misled  as  to  the  significance  of  that  which  his  palpation  may 


Fig.  48. — Dorso-lumbar  kyphosis.     The  patient  is  sitting  as  erect  as  possible. 

discover.  The  eleventh  dorsal  spine  takes  a  horizontal  direc- 
tion, and  in  some  cases  this  makes  either  a  very  narrow  space 
between  it  and  the  tenth  or  a  very  wide  space  between  it  and 
the  twelfth. 

Dorso-lumbar  Articulation. — The  junction  of  the  dor- 
sal and  lumbar  regions  is  very  flexible.  A  large  portion  of 
flexion  and  extension  of  the  spinal  column  is  made  in  this 
articulation.  The  most  common  condition  noticeable  in  the 


PRINCIPLES  OF   OSTEOPATHY. 


185 


lower  dorsal  region  is  increased  prominence  of  the  spines,  and 
incipient  kyphosis.  This  condition  frequently  affects  the  junc- 
tion of  the  dorsal  and  lumbar  regions,  as  in  Fig  48. 

Kyphosis — Lower  Dorsal. — A  slight  kyphosis  in  the 
lower  dorsal  region  is  indicative  of  loss  of  tone  in  the  extensor 
muscles  governing  the  articular  surfaces.  The  spines  are  sep- 
arated farther  than  normal  and  the  inferior  articulating  sur- 
faces are  partly  uncovered  by  the  superior  ones.  See  Fig.  48. 


Fig.   49. — Lumbar   region.      Side   view- 
normal. 


Fig.   50. — Lumbar    region, 
view — normal. 


Rear 


This  weakened  condition  of  the  back  may  be  brought  on  by 
injury,  or  reflexes  from  the  bowels  or  kidneys.  Continual  vi- 
bration of  the  spinal  column,  as  in  cases  of  street  car  men, 
weaken  the  back,  and  then  functional  disturbances  of  the  kid- 
neys are  noted. 

Lumbar  Region. — Figs.  49  and  50  illustrate  the  lateral 
and  posterior  appearance  of  the  normal  lumbar  vertebrae.  The 
spinous  processes  are  easily  palpated  in  this  region.  Their 
development  varies  enormously  in  different  individuals.  The 
formation  of  the  articular  processes  prevents  any  rotation, 


186  PRINCIPLES  OF  OSTEOPATHY. 

hence  we  do  not  find  any  lateral  subluxations  in  this  region. 
The  position  of  individual  vertebrae  is  rarely  affected. 
"Breaks,"  that  is,  separations  of  the  spines,  are  sometimes 
noted,  but  not  often.  Violence  is  the  chief  cause  of  these  sep- 
arations. The  muscles  in  this  region  are  thick  and  powerful, 
hence  their  influence  is  not  exerted  so  much  on  individual  ver- 
tebrae as  upon  the  whole  series  of  vertebrae.  Therefore  we 
find  curves  instead  of  subluxations  in  this  region.  Exagger- 
ation of  the  normal  movements  is  responsible  for  kyphosis, 
lordosis  or  scoliosis.  Extreme  weariness  as  a  result  of  main- 
taining a  sitting  or  standing  position  leads  the  individual  to 
shift  the  weight  of  the  body  so  as  to  take  some  advantage  of 
the  ligaments  which  limit  a  movement. 

The  strength  and  flexibility  of  the  lumbar  region  is  fre- 
quently a  very  good  criterion  of  the  patient's  bodily  vigor.  It 
is  easier  to  affect  this  portion  of  the  spinal  column  by  lever- 
age movements  than  any  other  region. 

Examination  of  the  Ribs. — The  position  of  the  ribs  is 
always  noted  by  the  osteopathic  physician.  It  is  noted  in 
medical  text-books  on  diagnosis  that  the  general  conforma- 
tion of  the  thorax  is  indicative,  to  a  variable  degree,  of  either 
the  past  medical  history  of  the  individual  or  is  evidence  of 
the  present  existence  or  predisposition  to  certain  diseases.  A 
full,  round,  nonflexible  chest  denotes  asthma  or  emphysema; 
flat  chest  denotes  tendency  to  tuberculosis,  etc.  These  state- 
ments are  generalizations  based  on  long  observation,  and  are 
usually  very  near  the  truth.  The  respiratory  movements  should 
be  noted,  whether  full  and  free  compared  with  the  capacity  of 
the  thorax. 

The  osteopathic  physician  goes  farther  than  these  excel- 
lent generalizations  in  his  diagnosis.  The  relation  and  po- 
sition of  each  individual  rib  are  extremely  important.  The  con- 
dition of  the  whole  thorax,  and  its  contents,  is  dependent  on 
the  relations  of  the  bones  which  form  it.  With  this  idea  in 
mind,  a  careful  examination  of  each  rib  is  made. 

The  ribs  are,  normally,  quite  moveable.  Their  spinal 
articulations  are  so  arranged  that  an  easy  rise  and  fall  of  the 
shaft  of  the  rib  is  permitted.  The  rise  and  fall  is  the  result 


PRINCIPLES   OF  OSTEOPATHY. 


187 


of  rotation  of  the  rib  on  an  axis  passing  through  the  costo- 
central  and  costo-transverse  articulations. 

Costo-central  Articulations. — The  costo-central  articu- 
lations of  the  first,  tenth,  eleventh  and  twelfth  ribs  have  no 
interarticular  ligament.  The  movement  of  the  heads  of  these 
ribs  is  limited  by  the  capsular  ligament.  The  heads  of  all  the 
other  ribs  are  held  in  place  by  interarticular  ligaments  attached 
to  ridges  on  the  heads  of  the  ribs  and  to  the  intervertebral 
disks. 

Costo-transverse  Articulations. — The  tubercles  of  the 
ribs  articulate  with  the  transverse  processes  of  the  vertebrae 


Fig-    Si- — Norn*al   relations   of   the  fifth   and   sixth   ribs. 

forming  arthrodial  joints.  The  superior  costo-transverse  lig- 
aments prevent  the  dropping  down  of  the  costo-transverse 
articulation.  There  is  very  limited  gliding  movement  in  this 
articulation.  As  before  stated,  the  movement  in  the  costo- 
central  and  costo-transverse  articulations  is  rotation.  The 
shaft  of  the  rib  lies  obliquely  downward,  therefore  the  rota- 
tion of  the  rib  during  inspiration  turns  the  anterior  extremity 
upward  and  outward.  The  axis  of  the  rotation  through  the 
costo-vertebral  articulations  is  obliquely  downward,  there- 
fore the  lateral  position  of  the  shaft  of  the  rib  is  elevated  dur- 
ing inspiration  and  the  lower  border  is  turned  outward. 

Co-ordination. — Fig.  51  illustrates  the  normal  obliquity 
of  the  fifth  and  sixth  ribs.     When  the  contraction  of  all    the 


i88  PRINCIPLES  OF  OSTEOPATHY. 

muscles  of  respiration  is  properly  co-ordinated,  the  intercostal 
spaces  are  all  equal  in  width.  The  respiratory  rhythm  should 
be  equal  in  all  parts  of  the  thorax. 

When  through  some  nervous  reflex,  inspiration  is  made 
difficult,  the  inspiratory  muscles  expand  the  thorax  to  its  fullest 
extent  and  retain  the  expansion.  Then  the  diameters  of  the 
thorax  are  increased.  This  position  of  extreme  inspiration  is 
typical  of  the  asthmatic  chest. 

Inco-ordination. — There  may  be  lack  of  co-ordination 
of  the  muscles  in  any  intercostal  space.  This  inco-ordination 
may  be  manifested  by  too  much  contraction  or  relaxation.  The 
result  is  a  change  in  the  normal  width  of  an  intercostal  space. 
•,  Nervous  Control  of  Respiration. — Respiration  is  carried 
on  by  a  complicated  mechanism.  Its  chief  center  of  normal 
control  is  in  the  medulla,  but  subsidiary  centers  in  linear  series 
exist  in  the  spinal  cord.  Each  spinal  nerve  which  innervates 
intercostal  muscles  or  other  muscles  of  inspiration  arises  from 
a  subsidiary  respiratory  center.  One  of  these  subsidiary  cen- 
ters may  become  too  active  or  passive  as  a  result  of  local  irri- 
tation, due  to  circulatory  changes.  The  muscles  governed  by 
this  disturbed  center  will  not  act  harmoniously,  hence  the 
rhythmical  movement  of  all  the  ribs  is  interfered  with. 

We  have  noted  that  spinal  muscles  contract  unevenly  as  a 
result  of  direct  spinal  injury,  exposure  of  the  skin  over  them  to 
cold,  or  from  visceral  reflexes.  The  respiratory  muscles  are 
subjected  to  the  same  conditions.  A  lateral  subluxation  in  the 
dorsal  region  carries  its  articulated  rib  with  it.  Palpation  will 
discover  their  changed  relations.  A  kyphosis  in  the  dorsal 
region  causes  the  ribs  to  rotate  upwards,  thus  increasing  the 
diameters  of  the  thorax.  Lordosis  in  this  region  has  the  op- 
posite effect. 

Costal  Subluxations. — Figs.  52  and  53  illustrate  the 
changes  in  spacing  of  the  ribs  due  to  inco-ordination  of  mus- 
cular contraction.  These  positions  of  the  ribs  are  spoken  of  as 
costal  subluxations.  In  Fig.  52  the  upper  rib  is  rotated  down- 
ward as  a  result  of  a  contraction  of  the  intercostal  muscles  of 
the  space  below  it  or  the  relaxation  of  those  above  it.  Palpa- 
tion elicits  sensitiveness  at  the  lower  border  of  this  fifth  rib. 


PKIXCIPLES  OF  OSTEOPATHY. 


189 


The  sensitiveness  is  usually  found  where  there  is  compression 
due  to  the  dropping  of  the  rib  and  the  contraction  of  the 
muscles.  This  rib  might  have  become  displaced  as  a  result 
of  violence,  or  the  patient  might  have  been  exposed  to  cold 
air  while  sweaty,  or  some  disease  of  another  part  of  the  body 
might  have  caused  sufficient  weakness  to  allow  this  rib  to  drop 
as  a  result  of  pressure  occasioned  by  the  position  in  bed  or 
otherwise. 

Whatever  the  cause  of  these  subluxations,  they  certainly 
become  sources  of  great  irritation  to  the  nervous  system.  Some- 
times the  bodv  becomes  accommodated  to  these  subluxations, 


Fig.  52. — Approximation  of  the  fifth  and  sixth    ribs. 

but  the  fact  that  cases  of  asthma  have  been  cured,  after  years 
of  suffering,  by  reducing  these  malpositions  is  prima  facie  evi- 
dence that  accommodation  is  something  that  can  not  always  be 
depended  on. 

The  heads  of  the  second  to  ninth  ribs  cannot  be  dislocated 
without  rupture  of  the  interarticular  ligaments.  Considerable 
change  in  the  position  of  the  shaft  of  the  rib  occasions  very 
little  change  in  the  position  of  the  head  of  the  rib. 

First  Rib. — The  first  rib  does  not  move  in  the  same 
manner  as  those  below.  The  attachment  of  the  scalenus  an- 
ticus  keeps  the  shaft  always  raised.  No  matter  how  flat  the 
remainder  of  the  thorax  may  be,  the  first  rib  stands  out  promi- 


i  go 


PRINCIPLES  OF  OSTEOPATHY. 


nently.  The  chief  change  in  its  position  is  due  to  the  con- 
traction of  the  scalenus  anticus,  therefore  it  needs  to  be  de- 
pressed rather  than  elevated. 

Tenth  Rib. — The  head  of  the  tenth  rib  is  articulated 
with  the  body  of  the  tenth  vertebra,  there  is  no  interarticular 
ligament.  This  allows  freer  movement.  Its  anterior  extrem- 
ity is  insecurely  articulated  to  the  cartilage  of  the  ninth  rib. 
This  connection  is  frequently  broken,  thus  making  an  added 
floating  rib. 

Eleventh  and  Twelfth  Ribs. — The  eleventh  and 
twelfth  ribs  are  very  loosely  articulated  to  the  vertebrae.  They 


Fig.     S3- — Separation     of    the    fifth    and    sixth    ribs. 

have  no  costo-transverse  ligaments,  hence  depend  on  the  action 
of  muscles  to  hold  them  in  place.  They  are  frequently  found 
rotated  upward  or  downward. 

We  have  endeavored  to  show  that  the  normal  movements 
of  the  ribs  as  a  whole  may  become  very  abnormal  when  made 
individually  or  out  of  rhythm  with  each  other.  The  depres- 
sions or  elevations  of  individual  ribs  have  not  dislocated  their 
articulations ;  they  have  merely  carried  and  retained  them  in 
positions  out  of  harmony  with  the  remainder  of  the  ribs.  They 
have  become  discordant  members  of  a  harmonious  body,  and 
unless  made  to  co-operate  for  the  general  welfare,  they  will 
rapidly  make  other  members  inharmonious. 


PEINCIPLES   OF  OSTEOPATHY. 


191 


54- — Normal  surface  markings  of  the  relations  of  the  sacrum  and  ilia. 


192 


PRINCIPLES  OF  OSTEOPATHY. 


Effect  of  Position  of  Vertebrae  on  Position  of  Ribs. — 
Lack  of  symmetry  in  the  dorsal  vertebrae  causes  a  change  in 
the  position  of  the  ribs.  Both  conditions  can  be  corrected  by 
reduction  of  the  vertebral  subluxations. 

Clavicles. — The  clavicles  may  be  elevated  or  depressed 
by  muscular  contraction.  Their  depression  affects  the  vessels 
crossing  the  first  rib  to  and  from  the  upper  extremity.  The 
subclavius  muscle  is  responsible  for  depression  of  the  clavicle. 


Fig-  SS- — Normal  relations  of  sacrum  and  ilium. 

Sacro-iliac  Articulation. — The  articulation  between  the 
sacrum  and  the  ilium  is  variously  described.  Some  claim  it 
has  a  synovial  membrane;  others  deny  it.  It  may  be  that  age 
and  sex  have  much  to  do  with  this  question.  Ordinarily  there 
is  no  movement  in  this  articulation.  It  serves  the  same  pur- 
pose for  the  pelvis  as  the  cranial  sutures  do  for  the  head,  that 
is,  to  minimize  shocks.  The  articular  surfaces  of  the  sacrum 
and  ilium  are  covered  with  cartilage,  the  ligaments  are  strong, 
muscular  contraction  has  no  effect  on  their  relative  positions, 
nothing  but  a  very  severe  shock  could  displace  them. 


PEIXCIPLES  OF  OSTEOPATHY. 


193 


Fig.    36. — Upward    and    forward    dislocation    of   the    right    ilium. 


I94 


PRINCIPLES  OF  OSTEOPATHY. 


According  to  the  above  facts  and  our  definition  of  the 
term  subluxation,  nothing  but  a  dislocation  can  take  place  in 
this  joint.  There  is  no  normal  movement,  hence  any  change 
in  the  relation  of  surfaces  is  a  dislocation.  Whenever  the  ilium 
is  found  raised  above  its  normal  relations  with  the  sacrum,  the 
patient  will  give  a  history  of  accident. 

Fig.  54  illustrates  the  osseous  relations  on  the  posterior 
surface  of  this  articulation.  Normally  the  posterior  superior 
spines  of  the  ilia  are  on  a  horizontal  line  running  through  the 


Fie-  57- — Ilium  forced  upward  and  forward. 

second  sacral  spine.  The  crests  of  the  ilia  are  on  a  level  with 
the  fourth  lumbar  spine.  Fig  55  shows  these  bones  in  their 
normal  relations. 

The  Nerves  Affected. — The  structures  which  are  quite 
liable  to  irritation  by  dislocation  of  the  ilium,  are  the  nerves 
passing  out  and  in  through  the  great  and  lesser  sacro-sciatic 
foramena;  also  the  lumbar  nerves  in  relation  with  the  psoas 
magnus  muscle. 

Symptoms. — From  the  symptoms  complained     of     in 


PK1NCIPLES   OF  OSTEOPATHY.  195 

five  cases  observed  by  the  author,  we  note  the  following :  first, 
a  soreness  on  the  bruised  part,  which  soon  ceases  to  attract 
attention,  then  pains  in  the  extremity  resembling  rheumatism ; 
about  this  time  the  patient  seeks  relief,  is  treated  by  the  ordi- 
nary drug  methods  with  no  success.  During  these  months  of 
drug  treatment  the  hip  rotators  begin  to  contract  and  stiffen 
the  joint.  Within  eighteen  months  after  the  accident  the  hip 


Fig.  s8. — Ilium  forced  upward  and  backward. 

joint  has  lost  its  function.  It  always  becomes  fixed  in  the 
extended  position.  Pain  is  practically  constant. 

Physical  examination  showed  the  relations  pictured  in 
Fig.  56.  The  crest  and  superior  posterior  spine  of  the  ilium 
were  above  their  normal  relations.  The  leg  on  the  injured  side 
was  shortened.  These  five  cases  presented  almost  exactly  the 
same  symptoms.  The  upward  and  backward  position  of  the 
ilium  is  illustrated  in  Figs.  58  and  59. 

The  shape  of  the  great  sacro-  sciatic  foramen  is  changed. 

Fig.  57  illustrates  an  upward  and  forward  position  of  the 
ilium.  The  obliquity  of  the  pelvis  at  the  time  of  the  acci- 
dent has  much  to  do  with  the  direction  in  which  the  luxation 


196 


PEINCIPLES  OF  OSTEOPATHY. 


takes  place.  When  the  luxation  is  caused  by  a  severe  shock 
on  the  posterior  surface  of  the  tuber  ischii,  the  ilium  is  twisted 
and  the  superior  posterior  spine  is  very  prominent,  but  below 
the  level  of  the  second  sacral  spine.  In  one  case  examined  the  pa- 
tient was  jolted  out  of  a  spring  seat  and  struck  on  the  tire  of  the 
wagon  wheel.  The  above  described  position  of  the  ilium  re- 
sulted. Fig.  60  gives  the  surface  indications. 


P'S-   59- — Posterior  superior  spine  of  the  ilium  is  too  prominent. 

Hypersensitiveness  will  be  found  internal  to  the  posterior 
superior  spine  of  the  ilium,  center  of  the  crest  of  the  ilium 
and  over  the  crest  of  the  pubes. 

Fig.  61  is  a  drawing  from  an  X-ray  photograph  of  a  lux- 
ated left  ilium.  Quite  a  number  of  cases  of  luxated  ilia  have 
been  reported  in  osteopathic  literature.  The  reports  are  fa- 
vorable. We  are  compelled  to  report  unfavorably  on  all  cases 
we  have  seen.  This  is  a  serious  luxation,  and  one  not  easily 
reduced.  None  of  my  cases  were  examined  osteopathically 
until  after  a  lapse  of  two  years.  During  these  two  years  move- 
ment in  the  hip  was  lost  and  the  ilia  became  absolutely  fixed. 


PRINCIPLES  OF  OSTEOPATHY. 


197 


Fig.    60. — Posterior    superior    spine   of   the    ilium    is    prominent  'and    slightly    below 
the  second   sacral  spine. 


198 


PRINCIPLES  OF  OSTEOPATHY. 


In  one  case  sufficient  force  was  used  to  move  the  ilium,  but 
it  could  not  be  forced  into  its  normal  position.  Pain  was  greatly 
relieved  in  all  cases. 

Sacro-vertebral      Articulation. — The      articulation      be 
tween  the  sacrum  and  fifth  lumbar  is  one  which  is  subject  to 


Fig.  61. — Dislocation  of  left  ilium  upward  and  backward,  i,  Sacrum;  2,  sth 
Lumbar  Vertebra;  3,  4th  Lumbar  Vertebra;  4,  4,  Illiac  Fossae;  5,  5,  Head  of 
Femur;  6,  6,  Lesser  Trochanter  of  Femur;  7,  7,  Pubes;  8,  8,  Obturiator  Fora- 
men; 9,  9,  Tuberosity  of  ischium;  10,  10,  Greater  Sacro-sciatic  Foramen;  n, 
Spine  of  Ischium. 

great  strain.  The  thick  cartilage  between  the  bodies  of  these 
bones  allows  considerable  compression  and  thereby  preserves 
the  articulation  from  harm.  It  is  not  uncommon  to  find  the 
fifth  lumbar  forced  too  far  anterior  by  the  obliquity  of  the 
sacrum.  This  articulation  seems  to  be  the  one  principally  con- 
cerned in  lordosis  of  the  lumbar  region.  In  connection  with 
this  malposition  we  find  pelvic  disorders  resulting  from  irri- 


PEINCIPLES  OF  OSTEOPATHY.  199 

tation  of  the  hypogastric  plexus  situated  on  the  anterior  sur- 
face of  this  vertebra. 

Every  individual  has  his  or  her  particular  develop- 
ment. When  examining  patients  this  must  be  taken  into 
consideration.  All  subluxations  must  be  judged  according  to 
the  condition  of  the  reflexes  along  the  nerve  tracts  which  they 
might  influence. 

Summary. — A  subluxation  is  evidence  of  unequal  ac- 
tivity of  opposing  muscles,  caused  by  twist,  strain,  fall,  ther- 
mal change  or  reflex  irritation  from  viscera.  It  is  an  evidence 
of  vital  activity  unevenly  manifested.  The  mechanical  condi- 
tion which  we  call  a  lesion  may  be  only  evidence  of  a  lesion 
which  lies  in  the  excessively  active  muscle  or  at  some  other 
point  in  close  nervous  connection. 

A  subluxation  may  be  called  a  primary  lesion  when  it  re- 
sults from  accident.  It  is  secondary  when  due  to  reflex  ac- 
tion. It  is  not  always  possible  to  determine  whether  a  lesion 
is  primary  or  secondary,  but  in  general  it  is  best  to  reduce 
them  wherever  found  if  any  disturbance  can  be  traced  to 
them. 

In  rare  instances  one  treatment  has  been  found  sufficient 
to  reduce  a  subluxation.  The  fact  that  the  majority  of  cases 
must  be  treated  two  or  three  months  proves  that  they  are  not 
easily  kept  reduced. 


CHAPTER  X. 


SOUNDS   PRODUCED  IN  JOINTS  BY  MANIPULA- 
TION. 

Normal  Sounds. — It  is  not  uncommon  to  hear  peculiar 
sounds  accompanying  the  normal  movement  of  joints. 
These  sounds  are  indicated  by  popular  terms,  such  as 
"cracking,"  "snapping,"  and  "popping."  They  are  so  com- 
mon that  every  one  has  heard  them,  either  in  their  own 
bodies  or  those  of  friends.  Pulling  the  fingers  is  the  best 
known  method.  It  is  commonly  supposed  that  such  a 


200  PEINCIPLES   OF  OSTEOPATHY. 

method,  if  persisted  in,  will  enlarge  the  joints.  I  doubt 
whether  there  is  any  proof  of  this.  Doubtless  the  fear  of 
it  originated  as  an  effort  to  frighten  some  one  in  whom  the 
phenomenon  was  easily  produced.  Loose  jointed  people 
are  able  to  produce  sounds  in  many  joints  by  carrying 
normal  movements  to  the  limit.  Scarcely  any  moveable 
joint,  in  which  the  ligaments  and  muscles  are  normally 
relaxed  is  free  from  the  possibility  of  producing  sound 
when  the  opposing  muscles  are  contracted  unevenly ;  i.  e., 
either  the  flexors  or  extensors  predominating.  The  joint 
surfaces  will  slip  upon  each  other  suddenly,  thus  producing 
the  sound.  After  it  has  been  once  made,  it  is  rarely  re- 
peated without  there  has  been  an  interval  of  rest  during 
which  the  muscles  change  their  tension.  The  cracking  in 
the  tempero-maxillary  articulation  can  be  repeated  until 
the  structures  ache  because  it  is  occasioned  by  the  sliding 
of  the  interarticular  cartilage  onto  the  eminentia  articu- 
laris.  The  wrist  and  shoulder  are  capable  of  producing 
frequent  sounds  on  account  of  their  free  movement  and 
the  many  directions  in  which  the  force  is  applied. 

Abnormal  Sounds. — A  large  number  of  sounds  which 
originate  in  joints  are  abnormal ;  i.  e.,  the  joints  are  not 
normal  or  else  these  particular  sounds  would  not  be  pro- 
duced. Some  of  these  sounds  are  familiar  to  all  physicians. 
They  result  from  forced  motion,  actively  or  passively  made, 
in  a  joint  having  limited  movement  as  a  result  of  injury; 
or  intracapsular  deposits  due  to  disease.  Another  class  of 
sounds  are  produced  by  forced  movement,  passive,  in  joints 
having  lost  some  of  the  normal  relations  of  their  surfaces. 

Pathology  of  Joints  Producing  Abnormal  Sounds. — It 
may  be  well  to  recount  systematically  the  conditions  in 
which  passive  movement  of  joints  produces  sounds.  In 
this  way  we  can  note  the  difference  between  the  characters 
of  sounds  usually  recognized  by  physicians,  and  those 
especially  peculiar  to  manipulative  treatment  of  sublux- 
ations. 

The  breaking  of  adhesions  between  articular  surfaces 
produces  a  sound  comparable  to  that  occasioned  by  the 


PEIXCIPLES   OF   OSTEOPATHY.  201 

breaking  of  a  green  stick  in  which  the  fibres  break  indi- 
vidually as  the  force  becomes  greater  and  greater. 

Synovial  adhesions  are  due  to  many  causes,  the  sim- 
plest of  which  are  slight  injury  and  non-use  of  a  joint.  An 
injury  sufficient  to  cause  slight  efforts  at  repair,  when 
accompanied  by  rest,  will  result  in  a  few  adhesions.  Volun- 
tary movement  of  the  joint  is  arrested  by  these  adhesions. 
Such  conditions  frequently  follow  a  sprain  or  the  splinting 
of  a  joint,  just  above  or  below  a  fracture.  The  joint  may 
be  quite  well,  but  by  keeping  it  perfectly  fixed  during  the 
repair  of  the  fracture,  the  periarticular  structures  loose 
their  elasticity  and  a  few  adhesions  may  form  within. 

Sometimes  a  timid  person  may  be  so  fearful  of  moving 
a  slightly  sprained  joint  that  adhesions  form  and  control 
of  the  joint  is  lost.  I  was  recently  called  to  examine  a. 
foot  which  was  very  painful  and  useless.  Seven  months 
previously  the  ankle  was  sprained.  The  foot  had  not  been 
used  since  that  injury.  Found  the  foot  stiff,  cold  and  rest- 
ing on  a  pillow.  Examination  revealed  slight  motion  which 
seemed  to  be  limited  by  elastic  bands.  There  was  no  inflam- 
mation of  the  foot.  Sudden  force  applied  first  in  direction 
of  flexion  then  extension,  caused  a  series  of  cracking  sounds 
which  indicated  the  rupturing  of  adhesions.  The  range  of 
motion  instantly  increased.  If  these  adhesions  had  been 
broken  six  months  before,  much  of  the  muscular  atrophy 
of  the  leg  and  thigh  would  have  been  avoided. 

A  patient  with  broken  femur,  having  been  kept  in  bed 
twelve  weeks  was  unable  to  move  the  knee  on  account  of 
adhesions  formed  during  period  of  non-action  due  to  splint- 
ing. Forcible  flexion  of  the  knee  a  little  each  day  gradually 
broke  the  adhesions  until  movement  was  nearly  normal. 

These  are  the  cases  with  which  all  physicians  are 
familiar.  The  sounds  produced  are  not  repeated  at  any 
time  following  the  first  forcible  movements.  Such  adhe- 
sions as  these  are  due  to  rest,  not  without  some  slight  in- 
jury. I  do  not  believe  that  non-use  alone  is  capable  of 
causing-  adhesions. 


202  PRINCIPLES  OF  OSTEOPATHY. 

Rheumatic  joints  sometimes  manifest  conditions  simi- 
lar to  sprains.  Adhesions  form  during  the  period  of  in- 
flammation and  persist  after  its  subsidence.  Rupturing 
these  by  sudden  force  frequently  restores  normal  movement. 

All  the  foregoing  conditions  are  the  result  of  some 
degree  of  inflammation.  Forced  movement  breaks  the 
adhesion,  which  makes  a  sound  as  it  breaks.  There  is  no 
repetition  of  the  sound  in  succeeding  movements. 

The  semilunar  cartilages  of  the  knee  joint  may  become 
displaced  and  cause  great  pain,  with  loss  of  motion.  A  case 
recently  under  treatment  gave  history  of  frequent  accident 
of  this  kind  while  riding  a  bicycle.  When  extending  the 
leg  to  push  the  peddle  down,  the  force  was  exerted  with 
the  knee  somewhat  everted.  Excruciating  pain  came  on 
suddenly  and  the  leg  could  not  be  extended.  Examination 
revealed  a  very  sensitive  spot  at  the  outer  and  anterior  sur- 
face of  the  joint.  The  semilunar  cartilage  slipped  forward 
and  blocked  the  extension  of  the  joint.  By  taking  the  leg 
between  my  knees  and  making  thumb  pressure  on  the  pain- 
ful prominent  spot,  then  gently  flexing  and  slightly  rotating 
the  tibia  on  the  condyles  of  the  femur,  followed  by  quick 
extension,  a  distinct  sound  was  elicited  and  the  action  of 
the  joint  was  restored.  The  sound  indicated  replacement 
of  the  cartilage. 

It  has  been  supposed  that  much  of  the  work  of  oste- 
opaths consisted  in  breaking  adhesions  which  were  simple 
enough,  but  happened  not  to  have  been  strictly  attended 
to  by  the  surgeons.  There  is  much  chance  to  misinterpret 
the  work  of  the  osteopaths  in  reducing  subluxations.  Med- 
ical men  of  established  schools  of  medicine  have  failed  to 
closely  analyze  the  structural  condition  of  joints  before  and 
after  manipulation,  hence  they  have  jumped  to  the  con- 
clusion that  all  of  our  work  was  of  that  kind,  called  "bone 
setting,"  for  want  of  a  better  descriptive  term.  This 
appelation,  "bone  setting,"  is  a  popular  one,  first  used  in 
England  to  describe  the  work  of  individuals,  usually  un- 
educated, who  treated  patients  by  manipulation  of  joints 


PEIXCIPLES  OF  OSTEOPATHY.  203 

which  they  said  were  "out."  Quick  forceful  movements 
in  the  directions  of  normal  joint  actions  usually  resulted 
in  a  '"popping"  sound.  When  this  occurred,  the  "bone 
setter"  considered  his  work  accomplished. 

Aside  from  adhesion  the  conditions  which  we  find 
limiting  the  movements  of  joints  are  subluxations.  Whar- 
ton  P.  Hood,  M.  D.,  M.  R.  C.  S.,  furnished  the  Lancet  a 
description  of  what  was  commonly  called  "bone  setting." 
His  articles  were  published  in  that  journal,  March  and 
April,  1871.  The  articles  were  published  in  book  form,  the 
same  year  entitled,  "On  Bone  Setting  (so  called)  and  Its 
Relation  to  the  Treatment  of  Joints  Crippled  by  Injury, 
Rheumatism,  Inflammation,  etc."  Dr.  Hood  made  close 
observations  of  the  work  of  a  "bone  setter," — Mr.  Hutton. 
This  gentleman  sought  to  teach  Dr.  Hood  his  art  as  a  mat- 
ter of  gratitude  for  professional  attention  given  him  by  Dr. 
Peter  Hood.  In  the  pages  of  this  book  I  find  a  clear,  con- 
cise exposition  of  the  bone-setter's  art,  together  with  a 
record  of  the  observations  of  the  author,  who  had  the 
advantage  of  excellent  training  in  the  medical  arts.  There 
is  no  doubt  in  my  mind  as  to  the  similarity  existing  be- 
tween the  conditions  which  were  recognized  by  so-called 
"bone  setters"  and  those  which  have  formed  the  basis  for 
the  successful  advancement  of  Osteopathy.  The  difference 
lies  principally  in  the  educational  qualifications.  Dr.  Hood 
notes  that  the  manipulations  were  made  without  any 
knowledge  of  anatomy  and  physiology,  but  were  neverthe- 
less astonishingly  successful,  and  he  calls  attention  to  the 
fact  that  much  greater  success  with  less  probability  of  in- 
jury ought  to  result  from  these  manipulations  when  the 
true  pathology  of  the  joint  is  understood ;  i.  e.,  when  the 
operator  is  in  fact  a  trained  surgeon  thoroughly  versed  in 
the  details  of  anatomy.  Dr.  Hood  evidently  did  not  under- 
stand the  conditions  which  we  recognize  as  subluxations 
of  the  ribs  and  vertebrae,  although  he  came  very  near  to  it, 
as  you  will  observe  hereafter.  His  attention  was  princi- 
pally fixed  on  the  conditions  following  greater  or  lesser 
degrees  of  joint  inflammation  resulting  in  intra-articular 


204  PRINCIPLES  OF  OSTEOPATHY. 

adhesions  or  extra-articular  contractions.  In  the  case  of 
adhesions,  breaking  them  causes  a  sound  which  can  not 
be  repeated,  but  subluxations  may  occur  repeatedly  in  the 
same  joint,  each  reduction  causing  a  sound. 

In  Dr.  Hood's  chapter  on  Pathology,  I  find  the  fol- 
lowing: "Subluxations  of  tarsal  and  carpal  bones  must 
occur,  I  think,  in  a  considerable  number  of  instances.  I 
mean  by  subluxations,  some  disturbance  of  the  proper  re- 
lations of  a  bone,  without  absolute  displacement;  and  I 
believe  that  such  disturbance  may  be  produced  either  by 
the  traction  of  a  band  of  adhesion  about  the  joints,  or  by 
a  twist  or  other  direct  violence." 

Grant  the  possibility  of  subluxation  in  the  arthrodial 
joints  of  the  carpus  and  tarsus,  it  is  not  improbable  to  con- 
ceive of  them  in  any  other  joint.  As  a  pure  example  of 
"bone  setting,"  one  of  my  recent  cases  is  apropos.  A  lady 
stepped  on  some  small  hard  object,  the  point  of  contact 
being  just  under  the  instep.  Sharp  pain,  localized  on  top 
of  the  instep,  began  at  once  and  was  not  relieved  by  heat 
or  other  antiphlogistic  measures.  Forty-eight  hours  after 
the  onset  of  pain  I  was  called  to  examine  the  foot.  Found 
some  swelling  over  the  instep,  but  palpation  localized  the 
pain  in  the  articulation  between  the  scaphoid  and  internal 
cuneiform.  Any  attempt  at  local  movement  of  this  joint 
caused  sharp  pain.  The  patient  could  not  stand  on  the  foot 
on  account  of  the  pain,  which  was  increased  thereby.  Ex- 
tention  of  the  foot  with  firm  pressure  on  the  upper  side  of 
the  articulation  caused  a  very  loud  sound,  the  prominence 
of  the  scaphoid  was  not  so  apparent,  and  the  patient  could 
put  her  weight  on  the  foot  immediately.  This  was  a  case 
of  tarsal  subluxation.  If  the  same  degree  of  displacement 
had  existed  in  a  vertebral  articulation,  the  effect  on  circu- 
lation in  the  nerve  centers  of  the  cord  might  have  caused 
very  wide  spread  symptoms. 

The  subluxations  treated  by  "bone  setters"  have  usu- 
ally been  those  which  occasioned  pain  in  the  joint.  The 
osteopath  does  not  depend  upon  conscious  pain  as  a  symp- 
tom of  subluxation,  but  makes  palpation  the  true  guide. 


PEINCIPLES   OF   OSTEOPATHY.  205 

When  the  head  of  the  femur  is  forced  out  of  the  asce- 
tabulum,  there  is  more  or  less  tearing  of  ligaments,  with 
consequent  inflammation.  Replacement  of  the  head  is  not 
accomplished  without  a  distinct  sound.  The  sound  is  con- 
sidered as  audible  evidence  of  successful  operation.  The 
same  is  true  of  the  shoulder  joint.  The  great  range  of  move- 
ment in  these  joints  necessarily  requires  lax  ligaments, 
therefore  great  separation  of  the  joint  surfaces  is  possible. 
The  arthrodial  joints  in  all  parts  of  the  body  are  con- 
structed on  a  different  principle.  The  range  of  movement 
is  not  great  in  them,  and  their  ligaments  are  comparatively 
short.  The  form  of  the  bony  surfaces  of  the  arthrodial 
joints  does  not  limit  motion  as  is  the  case  in  enarthrodial 
joints. 

Replacement  of  the  head  of  the  femur,  or  humerus 
requires  it  to  move  over  a  ridge  of  bone  or -cartilage,  and 
when  it  sinks  suddenly  into  its  proper  pace  a  sound  is 
heard.  Probablv  the  sound  which  accompanies  the  reduc- 
tion of  a  subluxated  arthrodial  joint  can  be  explained  by 
the  sudden  readjustment  of  joint  surfaces,  even  though 
there  is  no  ridge  of  bone  or  cartilage  to  glide  over.  It  is 
hardly  probable  that  a  subluxated  joint  has  its  surfaces 
smoothly,  though  in  a  limited  area,  opposed  to  each  other. 
Forcing  a  greater  area  of  contact,  corrects  the  unevenly 
opposed  surfaces. 

A  subluxation  may  be  reduced  slowly,  and  in  such  an 
instance  no  sound  is  heard.  Quick,  sharp  force  is  required 
to  overcome  the  periarticular  tension  which  will  result  in 
sudden  replacement  with  sound. 

The  use  of  the  statement  by  some  osteopaths  that  a 
"joint  is  out"  or  a  "bone  is  out"  is  merely  the  direct  appro- 
priation of  the  "bone  setter's"  pet  phrase.  The  use  of  the 
phrase  "there,  it's  in,"  or  some  similar  one  when  the  sound 
of  the  reduction  is  heard,  is  also  an  appropriation  from  the 
same  source.  These  phrases  are  unscientific,  and  should 
not  be  used  by  any  one  who  pretends  to  understand  the 
true  pathology  of  the  condition  he  is  treating.  In  the  case 


206  PRINCIPLES  OF  OSTEOPATHY. 

of  sound  due  to  the  breaking  of  adhesions,  we  could  not 
truly  say  a  "bone  is  out,"  nor  in  the  case  of  subluxation  is 
it  right  to  describe  it  thus.  If  it  is  adhesion,  call  it  so; 
and  if  a  subluxation,  describe  it  carefully.  In  this  way 
definite  knowledge  of  joint  conditions  will  be  gathered. 

There  is  some  difference  of  opinion  between  osteopaths 
as  to  whether  a  subluxation  must  give  forth  a  sound  when 
properly  reduced.  Discussions  of  the  subject  thus  far  have 
not  settled  it.  It  seems  that  the  statement  made  previously 
in  this  chapter  that  slow  reduction  of  a  subluxation  by  re- 
laxing movements  will  not  cause  a  sound,  but  forceful  and 
sudden  relaxation  will  do  so,  about  covers  the  facts.  We 
know  that  subluxations  are  reduced  by  both  methods  with 
satisfactory  results. 

Elsewhere  I  have  called  attention  to  the  treatment  of 
subluxations.  (Chapters  XVIII  and  XIX).  For  com- 
parative purposes,  and  that  the  student  may  know 
what  was  understood  concerning  the  manipulative  treat- 
ment of  the  spinal  column,  previous  to  the  advent  of  oste- 
opathy, I  quote  a  portion  of  Dr.  Hood's  chapter  on  "Affec- 
tions of  the  Spine." 

"I  fear  it  must  be  admitted  that  the  great  importance 
of  the  spinal  cord,  and  the  gravity  of  its  diseases,  have 
rather  tended  to  make  professional  men  overlook  the  osse- 
ous and  ligamentous  case  by  which  it  is  enclosed,  and 
which  is  liable  to  all  the  maladies  that  befall  bones  and 
ligaments  elsewhere.  The  quack  on  the  other  hand,  who 
probably  never  heard  of  the  spinal  cord,  recognizes  the 
presence  of  structures  with  which  he  is  familiar,  and  deals 
with  them  as  he  does  in  other  situations.  The  result  is 
much  the  same  as  in  the  hip  joint.  The  quack  every  now 
and  then  cures  conditions  which  the  authorized  practitioner 
had  regarded  with  a  sort  of  reverence  because  they  were 
"spinal ;"  and  he  every  now  and  then  kills  a  patient  because 
this  reverence  did  not  exist  for  his  protection.  If  the  pro- 
fession generally  would  so  study  the  diseases  of  the  spinal 
cord  as  to  rescue  them  from  specialists,  the  first  step  would 


PRINCIPLES  OF  OSTEOPATHY.  207 

be  taken  towards  rescuing  the  diseases  of  the  vertebral 
column  from  quacks. 

"However,  the  matter  may  be  explained,  it  is  quite 
certain  that  many  people  now  resort  to  bone  setters,  com- 
plaining of  a  "crick,"  or  pain  or  weakness  in  the  back, 
usually  consequent  upon  some  injury  or  undue  exertion, 
and  that  these  applicants  are  cured  by  movements  of  flexion 
and  extension,  coupled  with  pressure  upon  any  painful 
spot. 

"In  a  few  cases,  Mr.  Hutton  was  consulted  on  account 
of  stiffness  about  the  neck  or  cervical  vertebrae;  and  he 
then  was  accustomed  to  straighten  them.  *  *  *  His 
left  forearm  would  be  placed  under  the  lowered  chin  of  the 
patient,  with  the  hand  coming  round  to  the  base  of  the 
occipital  bone.  The  right  thumb  would  then  be  placed  on 
any  painful  spot  on  the  cervical  spine,  and  the  chin  sud- 
denly elevated  as  much  as  seemed  to  be  required.  As  far 
as  my  observation  extends  the  instances  of  this  kind  were 
not  bonafide  examples  of  adhesions,  but  generally  such  as 
might  be  attributed  to  slight  muscular  rigidity,  or  even  to 
some  form  of  imaginary  malady.  The  benefit  gained  was 
probably  rather  due  to  the  pain  of  the  operation  and  the 
effect  produced  by  it  upon  the  mind  of  the  patient  than 
to  any  actual  change  in  the  physical  condition  concerned. 

"For  the  lower  regions  of  the  spine  he  had  two  methods 
of  treatment  differing  in  detail,  but  not  in  principle.  In 
the  first,  when  the  painful  spot  was  found  the  patient  was 
made  to  get  out  of  bed  and  to  stand  facing  its  side,  with 
the  front  of  the  legs  or  perhaps  the  knees — according  to 
the  height  of  the  patient  and  of  the  bedstead — pressed 
against  it.  She  was  then  told  to  bend  forward  until  the 
bed  was  touched  by  the  elbows.  His  left  arm  was  then 
placed  across  the  chest,  and  the  thumb  of  the  right  hand 
upon  the  painful  spot.  Firm  pressure  was  then  made  with 
the  thumb,  and  as  soon  as  he  felt  that  he  had  settled  him- 
self into  such  a  position  that  he  could  obtain  the  full  power 
of  the  left  arm,  the  patient  was  told  to  assume  the  erect 
posture  with  as  much  rapidity  and  vigor  as  she  could  com- 


208  PKINCIPLES   OF  OSTEOPATHY. 

mand.  This  movement  was  facilitated  and  expedited  by 
the  throwing  up  of  his  left  arm  and  the  opposing  force  of 
the  right  thumb.  As  a  rule  there  seemed  to  be  two  painful 
spots,  answering  to  the  upper  and  lower  border  of  the 
affected  vertebrae,  so  that  the  manoeuvre  would  require  to 
be  repeated. 

"In  the  second  method  the  patient  was  seated  in  a  chair 
placed  a  short  distance  from  the  wall,  so  that  the  feet  could 
be  firmly  pressed  against  it.  She  was  told  to  bend  forward 
and  place  her  arms  between  her  legs,  with  the  elbows  rest- 
ing against  the  inner  side  of  the  knees :  to  sit  firmly  on  the 
chair,  and  at  a  given  signal  to  throw  herself  upright.  The 
operator  passed  his  left  arm  under  the  chest,  placed  his 
right  thumb  on  the  painful  spot,  and,  in  order  to  obtain 
firm  and  resisting  pressure,  rested  his  elbow  against  the 
back  of  the  chair.  The  signal  being  given,  the  operator, 
keeping  the  fist  clenched,  so  as  to  support  his  thumb,  and 
the  elbow  being  held  firm  in  its  position,  when  the  patient 
throws  herself  upright,  resists  the  approach  of  her  back  to 
the  chair,  and  bends  her  head  and  shoulders  as  far  back- 
wards as  possible,  the  position  of  the  feet  preventing  any 
forward  movement. 

"These  two  methods  are  used  for  cases  in  which  pain 
is  present  in  the  dorsal  vertebrae  below  the  eighth,  or  in 
any  of  the  lumbar.  The  treatment  used  for  the  upper  dorsal 
and  lower  cervical  vertebrae  was  to  place  the  operator's 
knee  against  the  painful  spot,  and,  with  the  hands  placed 
upon  the  shoulders  to  draw  the  upper  part  of  the  body  as 
far  back  as  possible. 

"In  cases  where  pain  was  complained  of,  in  the  dorsal 
and  lumbar  region,  and  the  backward  movements  did  not 
afford  the  required  relief,  the  patient  was  made  to  bend 
sideways,  and  a  similar  process  was  gone  through  as  in  the 
other  manipulations. 

"As  a  commentary  on  all  this,  there  is  manifestly  little 
to  say,  except  that  the  size  of  the  vertebral  column  is  such 
as  to  admit  of  considerable  diminution  without  injury  to 
the  cord,  and  that  the  bones  and  ligaments  of  the  column 


PKINCIPLES  OF  OSTEOPATHY.  209 

as  already  observed  are  liable  to  the  same  results  of  injury, 
and  to  the  same  diseases,  that  befall  bones  and  ligaments 
elsewhere. 

"The  surgeon  who  is  consulted  about  a  case  of  spinal 
malady  should  first  of  all  make  sure  that  he  is  not  fright- 
ened by  a  bug  bear,  and  should  then  proceed  to  determine 
by  scientific  methods  of  examination  whether  or  not  he  is 
in  the  presence  of  disease  of  the  nervous  centres,  or  of 
caries,  abscess  or  other  destructive  change  in  the  vertebral 
column.  On  such  points  as  these,  no  man  who  possesses  a 
thermometer,  a  microscope  and  a  test  tube  has  any  excuse 
for  remaining  long  in  doubt;  and  if  he  is  able  to  exclude 
the  possibility  of  such  conditions,  he  may  then  regard  the 
spine  simply  as  a  portion  of  the  skeleton,  and  may  deal  with 
it  accordingly.  Here,  as  elsewhere,  injury  and  rest,  or  rest 
and  counter  irritation,  may  produce  adhesions  that  pain- 
fully limit  movement  and  that  may  at  once  be  broken  by 
resolute  flexion  and  extension.  Here,  as  elsewhere,  partial 
displacement  may  occur  and  may  be  rectified  by  pressure 
and  motion.  In  the  lower  cervical  the  dorsal  and  lumbar 
portions  of  the  spine,  the  change  of  position  of  any  single 
vertebrae  can  only  be  slight — enough  to  produce  pain  and 
stiffness,  but  not  enough  to  produce  visible  deformity.  In 
the  highest  region,  however,  partial  dislocations  are  some- 
times more  manifest.  The  following  case  is  quoted  from 
the  hospital  report  of  the  Medical  Times  and  Gazette  of 

August  5th,  1865;  'John  S ,  aged  21,  laborer,  of  St. 

Mary's  Cray,  was  admitted  on  May  26th,  1865,  under  Mr. 
Hilton.  States  that  he  has  been  ailing  for  the  last  three 
months ;  loss  of  appetite  and  general  debility ;  has,  how- 
ever, followed  employment.  On  Sunday,  May  14,  he  was 
stooping  down  to  black  his  boots  as  they  were  on  hi?  feet, 
when  suddenly  he  "felt  a  snap"  in  the  upper  and  back  pan 
of  his  neck ;  he  felt  as  if  someone  had  struck  him  there. 
About  a  quarter  of  an  hour  after  he  became  insensible  and 
continued  so  about  half  an  hour;  then  he  felt  a  stiffness 
and  numbness  at  the  sides  and  back  of  his  head  and  the 
back  of  his  neck,  with  a  fullness  in  the  throat  and  difficulty 


210  PKINCIPLES  OF  OSTEOPATHY. 

of  swallowing.  At  first  he  had  no  loss  of  power  over  his 
limbs,  only  slight  pain  down  his  right  arm ;  some  days 
after  admission,  however,  he  had  partial  loss  of  power  in 
the  right  arm,  which  shortly  recovered  itself.  On  admis- 
sion he  carries  his  head  fixed,  and  has  pain  on  slightest  at- 
tempt to  rotate,  flex,  or  extend  the  head;  his  jaw  is  par- 
tially fixed,  and  he  can  not  open  his  mouth  wide  enough 
to  admit  of  a  finger  being  passed  to  the  back  of  the 
pharynx;  his  voice  is  thick  and  guttural;  deglutition  not 
attended  by  any  great  uneasiness.  Complains  of  all  symp- 
toms before  enumerated.  Externally,  over  the  spine  of  the 
second  cervical  vertebrae,  there  is  a  tumor  hard  and  resist- 
ing, but  tender  on  pressure ;  this  is  evidently  formed  by 
the  undue  prominence  of  the  spine  of  the  axis  itself;  the 
tenderness  is  not  general,  but  circumscribed ;  the  parts  all 
around  are  numb.  He  was  put  on  his  back  on  a  hard  bed, 
his  head  was  slightly  elevated  and  a  small  sand  bag  was 
placed  beneath  the  projecting  spine;  and  the  whole  head 
maintained  in  a  fixed  position  by  larger  sand  bags.  He 
was  ordered  pulv.  Dov.  gr.  V;  hydr.  c.  creta ;  gr.  iij.,  bis 
die.  This  was  continued  for  about  ten  days,  when  his 
gums  became  affected  slightly,  and  it  was  then  omitted. 
Marked  improvement  has  taken  place  in  his  general  appear- 
ance and  more  particularly  in  his  special  symptoms.  He 
continued  thus,  till  July  3,  gradually  and  steadily  improving. 
He  then  had  acute  rheumatic  inflammation  of  the  right 
knee  and  elbow  joint,  followed  in  a  day  or  two  by  a  simi- 
lar state  in  the  left  knee  joint.  There  was  no  evidence  of 
a  pyaemic  state.  The  joints  were  blistered,  he  has  been 
treated  with  pot.  nitr.  and  lemon  juice  and  is  now  fast 
recovering.  The  tenderness  and  all  the  symptoms  have 
disappeared,  the  projection  still  remaining,  and  he  expresses 
himself  much  relieved  by  the  continued  rest  in  bed." 

"Mr.  Hilton,  in  remarking  on  this  case,  observed  that 
it  had  been  demonstrated  that  the  area  of  the  vertebral 
canal  might  be  diminished  by  one-third,  provided  that  the 
diminution  was  slowly  effected,  without  giving  rise  to  any 


PRINCIPLES   OF  OSTEOPATHY.  211 

alarming,  or  indeed  marked  symptoms  of  compression  of 
the  cord. 

"'Xow,  there  can  be  no  doubt  that  most  surgeons  would 
agree  that  Mr.  Hilton  exercised  a  sound  discretion  in  sim- 
ply placing  this  man  in  conditions  favorable  to  recovery, 
or  in  keeping  him  at  rest  until  the  axis  was  fixed  in  its  new 
position,  and  the  spinal  cord  accustomed  to  the  change  in 
its  relations.  There  can  be  as  little  doubt  that  Mr.  Hutton 
would  have  made  thumb  pressure  on  the  prominent  spine 
while  he  sharply  raised  the  head.  The  probability  is,  that 
he  would  by  this  manoeuvre  have  cured  his  patient;  the 
possibility  is  that  he  might  have  killed  him.  This  sort  of 
"make  a  spoon  or  spoil  a  horn"  practice  we  may  content- 
edly leave  to  quacks ;  and  without  risking  reputation  in 
doubtful  cases.  I  think  we  may  find  a  considerable  num- 
ber which  are  not  doubtful,  in  which  skilled  observation 
may  exclude  all  elements  of  danger,  and  in  which  the  recti- 
fication of  displacement,  or  the  rupture  of  adhesions,  will 
be  certainly  followed  by  the  most  favorable  results.  For 
the  discovery  of  these  cases  no  settled  rules  can  be  laid 
down,  since  they  can  only  be  known  by  negations — by  the 
absence  of  the  symptoms  that  would  give  warning  of 
danger.  The  diagnosis  must  be  made  in  each  instance  for 
itself,  and  in  each  must  depend  upon  the  sagacity  and  skill 
of  the  practitioner." 


CHAPTER  XL 


OSTEOPATHIC    CENTERS. 

Certain  points  on  the  surface  of  the  body  are  spoken  of 
as  "Centers."  This  word  has  become  a  part  of  the  osteopath's 
technical  vocabulary.  It  does  not  convey  to  the  mind  of  the 
osteopath  the  same  meaning  which  attaches  to  it  when  used 
in  physiological  text-books. 

A  physiological  functional  center  in  the  central  nervous 
system  is  that  point  where  the  action  of  a  certain  viscus  or 
other  structure  is  governed. 

An-  osteopathic  center  is  that  point  on  the  surface  of  the 


212  PRINCIPLES   OF  OSTEOPATHY. 

body  which  has  been  demonstrated  to  be  in  closest  central  con- 
nection with  a  physiological  center,  or  over  the  course  of  a 
governing  nerve  bundle. 

In  Chapter  III,  under  the  sub-heading  Segmentation,  ref- 
erence is  made  to  the  division  of  the  central  nervous  system  into 
sections  which  may,  to  a  moderate  degree,  functionate  inde- 
pendently. No  portion  of  the  nervous  system  ever  function- 
ates absolutely  independently.  The  action  of  every  portion  af- 
fects all  other  portions,  but  certain  areas  in  the  brain  and 
spinal  cord  seem  to  be  somewhat  set  apart  to  govern  or  co- 
ordinate the  physiological  activity  of  certain  organs.  Physi- 
ology has  demonstrated  a  large  number  of  these  centers. 

"Physiology  shows  how  not  only  the  individual  ganglia 
which  lie  in  the  intestines  function  with  relative  independence, 
but  how  even  structures  like  the  spinal  ganglia  frequently  reck- 
oned in  with  the  central  system  still  enjoy  relative  indepen- 
dence from  it  functionally." 

"What  we  know  of  the  anatomical  structure  and  of  the 
functions  of  the  central  nervous  system  of  vertebrates  forces 
us  more  and  more  to  the  conclusions  (i)  that  even  individual 
parts  of  the  central  system  are  themselves  in  a  position  to 
function  to  a  certain  extent  independantly,  and(2)that  even  the 
brain  and  spinal  cord  of  vertebrates  are  composed  of  a  series  of 
centers.  Whether  the  one  or  the  other  of  these  is  more  highly 
developed,  whether  they  are  in  connection  with  deeper  centers, 
whether  they  have  connections  among  themselves  and  with 
higher  centers,  determine  the  measure  of  the  higher  or  lower 
development  of  the  central  system.  We  will  find  later  that, 
in  the  course  of  the  development  of  a  class,  individual  centers 
connected  with  the  central  nervous  system  have  reached  a  high 
development,  while  others  have  arrived  at  a  certain  stage  (or 
reached  a  certain  type)  where  they  remain  stationary,  and 
throughout  all  subsequent  posterity  remain  everywhere  alike. 

"One  can  conceive  that  in  its  essentials  every  nervous 
system  is  composed  of  afferent  tracts  and  efferent  tracts,  and 
of  tracts  which  form  the  connection  of  the  elements  among 
themselves."  (Anatomy  of  the  Central  Nervous  System  of 
Man  and  of  Vertebrates  in  General.  Edinger,  page  26.) 


PEINCIPLES  OF   OSTEOPATHY.  213 

Anatomy  and  Physiology  demonstrate  that  from  a  cer- 
tain segment  of  the  spinal  cord  nerve  fibres  are  distributed 
to  skin,  skeletal  muscles,  involuntary  muscles  and  mucous 
membrane  of  viscera,  and  to  the  muscular  coats  of  the  arteries 
supplying  all  these  structures. 

Physiology  and  Pathology  demonstrate  that  impressions 
made  upon  sensory  elements  in  skin,  mucous  membrane,  mus- 
cle, or  other  structures,  are  carried  to  a  center  in  the  central 
nervous  system.  These  impressions  are  co-ordinated  in  this 
center,  and  affect  the  physiological  action  of  all  structures  in- 
nervated from  the  same  center.  When  we  speak  of  two  or 
more  structures  being  in  close  central  connection,  we  mean 
that  they  are  innervated  from  the  same  segment  of  the  central 
nervous  system. 

Diagnosis. — In  diagnosis  these  segments  serve  the  pur- 
pose of  calling  the  osteopath's  attention  to  the  condition  of 
several  correlated  structures.  For  example :  A  hyperaesthe- 
sia  at  any  point  along  the  spinal  column  fixes  the  attention  of 
the  osteopath  upon  all  the  structures  of  the  body  which  are 
innervated  from  the  segment  of  the  central  nervous  system 
which  furnishes  nerves  for  this  over-sensitive  area.  Exami- 
nation of  all  the  structures  thus  supplied  will  probably  dis- 
cover the  point  chiefly  affected. 

In  order  to  give  the  student  a  clear  insight  into  the  prin- 
ciples underlying  osteopathic  diagnosis,  we  will  examine  the 
osteopathic  centers  serially,  commencing  at  the  atlas. 

First  Four  Cervical  Nerves. — We  will  first  divide  the 
spinal  column  into  sections  according  to  the  location  of  certain 
groups  of  nerves.  Remember  that  these  divisions  are  made 
with  reference  to  the  points  of  exit  of  the  spinal  nerves  from 
the  spinal  column. 

The  first  section  contains  the  first  four  cervical  nerves. 
The  first  cervical  nerve  leaves  the  spinal  canal  between  the 
occipital  bone  and  the  atlas.  A  study  of  its  distribution  will 
inform  us  what  structures  are  governed  by  it.  Its  anterior  di- 
vision forms  a  part  of  the  cervical  plexus.  This  division  com- 
municates with  the  sympathetic  nerves  on  the  vertebral  artery, 
the  pneumogastric,  the  hypoglossal,  and  superior  cervical  sym- 


214  PRINCIPLES  OF   OSTEOPATHY. 

pathetic  ganglion.  It  innervates  the  Rectus  Lateralis  and  An- 
terior Recti. 

The  posterior  division  of  the  first  cervical  nerve  is  called 
the  suboccipital.  It  supplies  motor  fibres  to  the  posterior  Recti 
muscles  of  the  head,  the  Superior  and  Inferior  Oblique,  and 
the  Complexus.  Sensory  fibres  from  the  scalp  form  part  of 
this  nerve. 

Example  of  Hilton's  Law. — With  this  outline  of  dis- 
tribution before  us,  we  can  note  some  of  the  results  of  stim- 
ulation of  this  nerve.  Since  the  anterior  division  supplies  a 
few  fibres  to  the  occipito-atlantal  articulation,  we  have  an  ex- 
ample of  Hilton's  law  of  distribution  of  a  nerve  trunk.  The 
synovial  membrane  of  the  occipito-atlantal  articulation,  the 
muscles  which  govern  movements  of  the  joint,  and  the  skin 
over  the  joint  are  all  innervated  by  this  first  cervical  nerve. 

The  muscles  moving  the  occipito-atlantal  articulation  act 
according  to  impulses  reaching  the  point  of  origin  of  the  first 
cervical  nerve  over  sensory  fibres  ending  in  the  skin  covering 
the  back  of  the  head  and  this  articulation,  also  from  those 
ending  in  the  synovial  membrane  of  the  joint.  These  im- 
pulses are  co-ordinated  in  higher  centers  of  the  brain  which 
govern  equilibration.  The  muscles  of  this  joint  act  also  accord- 
ing to  our  will. 

The  Pneumogastric  Nerve. — Furthermore,  the  anterior 
division  of  this  nerve  communicates  with  the  pneumogastric, 
hypoglossal,  and  the  superior  sympathetic  ganglion.  The 
pneumogastric  has  such  a  wide  distribution  that  we  cannot 
afford  to  follow  all  of  its  paths  of  influence  at  this  time.  The 
student  is  referred  to  any  extended  work  on  anatomy  for  the 
details.  The  muscles  and  mucous  membranes  of  the  larynx 
are  innervated  by  the  pneumogastric,  hence  any  irritation  of 
the  larynx  may  reflex  impulses  to  the  center  of  origin  of  the 
first  cervical  nerve  and  cause  undue  contraction  of  the  mus- 
cles innervated  by  it.  This  muscular  contraction  can  result  in 
changing  the  relation  of  the  bones  forming  the  occipito-atlantal 
articulation  until  a  condition  exists  which  we  call  a  sublux- 
ation  of  the  atlas.  Having  followed  the  impulses  from  the  lar- 
ynx to  the  center  of  co-ordination  and  out  again  to  the  mus- 


PRINCIPLES  OF  OSTEOPATHY.  215 

cles  of  the  occipito-atlantal  articulation  with  consequent  sub- 
luxation,  we  may  profitably  note  the  fact  that  sudden  temper- 
ature changes  may  affect  the  skin  over  these  muscles,  arousing 
impulses  which  are  carried  to  the  center  of  co-ordination, 
thence  to  the  muscles,  causing  them  to  contract  with  result- 
ing subluxation.  Some  of  the  reflex  impulses  may  find  their 
way  to  the  larynx  and  cause  congestion  of  its  mucosa.  The 
atlas  may  be  subluxated  by  violence,  then  the  sensory  impulses 
originate  in  the  sy  no  vial  membrane  of  the  joint  and  in  the 
muscles  moving  the  joint.  These  impulses  may  be  reflected 
in  such  manner  as  to  affect  the  larynx,  pharynx  and  other 
structures  innervated  by  the  pneumogastric.  The  reflex  in- 
fluences existing  between  the  first  cervical  nerves  and  the 
pneumogastric  are  chiefly  confined  to  the  larynx  and  pharynx, 
because  spinal  nerves  usually  receive  sympathetic  reflexes  from 
the  segment  of  the  body  which  they  cover.  If  we  should  fol- 
low all  of  the  divisions  of  the  pneumogastrics,  we  would  find 
a  wonderful  diversity  of  distribution.  We  do  not  expect  that 
reflexes  from  the  heart,  lungs,  stomach,  etc.,  are  going  to  be 
subject  to  co-ordination  in  the  area  of  origin  of  the  first  cerv- 
ical nerve,  just  because  there  is  communication  between  the 
pneumogastric  and  this  nerve.  The  pharynx  and  larynx  are, 
in  part,  structures  governed  involuntarily,  and  hence  they  are 
in  large  part  removed  from  the  influence  of  nerves  carrying 
voluntary  impulses,  i.  e.,  spinal  nerves.  The  pneumogastric  is 
essentially  sympathetic  in  character.  The  tissues  of  the  lar- 
ynx and  pharynx  are  practically  under  the  influence  of  the 
first  cervical  nerve.  Your  attention  is  called  to  Hilton's  law 
as  he  has  stated  it  in  relation  to  mucous  and  serous  surfaces. 
"This  same  principle  of  arrangement,  anatomically,  physio- 
logically and  pathologically  considered,  is  to  be  observed,  with 
an  equal  degree  of  accuracy  in  the  serous  and  the  mucous  mem- 
branes. Thus  considered,  it  presents  a  principle  which,  if  it 
has  any  application  in  practice,  must  be  one  certainly  of  large 
extent." 

Since  the  spinal  accessory  forms  part  of  the  pneumo- 
gastric above  the  point  of  communication  between  that  nerve 
and  the  first  cervical,  we  can  perceive  the  reason  for  the  great 


2i6  PRINCIPLES  OF  OSTEOPATHY. 

influence  which  temperature  changes,  affecting  the  skin  over 
the  sterno-cleido-mastoid  and  trapezius  muscles,  have  on  the 
action  of  the  muscles  forming  the  suboccipital  triangles.  The 
spinal  accessory  innervates  the  sterno-cleido-mastoid  and  tra- 
pezius. These  muscles  will  contract  reflexly  when  the  sensory 
nerves  in  the  skin  over  them  are  affected  by  temperature 
changes.  The  action  of  these  muscles  affects  the  position  of 
the  head  chiefly  by  causing  movement  in  the  occipito-atlantal 
articulation  whose  accurate  adjustment  depends  on  the  mus- 
cles innervated  by  the  first  cervical  nerves. 

The  point  of  origin  of  the  first  two  cervical  nerves  is  prob- 
ably a  bilateral  center.  In  order  to  secure  co-ordinated  move- 
ments, both  sides  of  this  bilateral  center  must  act  recipro- 
cally, but  if  the  impulses  coming  into  the  center  from  one  side 
are  much  greater  in  number  and  intensity  than  those  enter- 
ing on  the  opposite  side,  this  reciprocity  of  action  may  be  in- 
terfered with  and  subluxation  result. 

The  Hypoglossal  Nerve. — The  Hypoglossal  nerve  is 
the  motor  nerve  to  the  muscles  of  the  tongue,  and  to  the  mus- 
cles moving  the  larynx  and  hyoid  bone.  It  communicates  with 
the  first  cervical  nerve.  Movement  in  the  occipito-atlantal  ar- 
ticulation affects  the  relations  of  the  points  of  origin  and  in- 
sertion of  the  muscles  innervated  by  the  hypoglossal ;  there- 
fore, impulses  passing  over  both  nerves  are  co-ordinated  at 
about  the  same  area. 

Superior  Cervical  Ganglion. — Probably  the  greatest 
cause  for  disturbance  along  the  course  of  the  first  cervical 
nerve  is  the  communication  with  the  superior  cervical  gan- 
glion and  the  sympathetic  plexus  on  the  vertebral  artery.  This 
communication  subjects  all  the  structures  innervated  by  the 
first  cervical  to  reflexes  initiated  in  various  areas  of  the  head, 
neck  and  brain. 

The  superior  cervical  sympathetic  ganglion  has  a  vaso- 
constrictor influence  over  the  blood  vessels  of  the  head,  neck 
and  brain.  It  is  a  well  known  clinical  fact  that  ice  applied  to 
the  surface  of  the  neck  over  the  occipito-atlantal  articulation 
will  cause  constriction  of  the  blood  vessels  of  the  brain.  This 
constriction  is  a  reflex  effect  due  to  the  communication  of  the 


PRINCIPLES   OF  OSTEOPATHY.  217 

first  cervical  nerve  with  the  superior  cervical  sympathetic 
ganglion. 

Suboccipital  Triangles. — When  the  first  cervical  nerve 
is  sensitive  to  moderate  pressure  over  the  suboccipital  tri- 
angles, we  may  be  sure  that  it  is  evidence  of  disturbance  of 
circulation  in  some  part  of  the  head,  neck  or  face.  We  look 
for  this  disturbance  in  the  structures  which  are  subjected  to 
the  greatest  amount  of  work,  i.  e.,  the  eye,  pharynx  or  larynx. 
The  brain,  last,  because  it  is  not  easily  fatigued.  Sensitive- 
ness is  nearly  always  associated  with  a  subluxated  atlas,  i.  e., 
one  is  indicative  of  the  other. 

Whether  the  subluxation  is  primary  or  secondary,  it  is 
a  source  of  irritation  and  must  be  reduced ;  therefore,  in  prac- 
tice our  treatment  is  applied  primarily  to  this  changed  struct- 
ure. The  results  of  practice  prove  this  to  be  the  best  method. 

Patients  rarely  complain  of  sharp  neuralgic  pain  in  the 
area  of  the  suboccipital  triangles.  A  dull  ache  or  tension  is 
the  usual  subjective  symptom. 

We  have  described  the  characteristics  of  this  center  with 
considerable  detail  in  order  that  the  student  may  understand 
how  thoroughly  an  accurate  knowledge  of  anatomy  and  phys- 
iology enters  into  the  work  of  the  osteopath.  Every  center 
must  be  understood  in  this  same  manner.  We  do  not  deem  it 
necessary  to  go  into  such  detail  in  describing  all  of  the  remain- 
ing centers  in  order  that  the  student  can  understand  their  sig- 
nificance. 

In  order  to  make  the  characteristics  of  the  first  cervical 
nerve  stand  out  prominently,  we  have  described  it  as  though 
it  were  individual  in  its  action  and  reaction.  This  is  not  strictly 
true.  Analysis  compels  us  to  note  ill-defined  separations  in 
the  nervous  system.  In  order  to  get  a  right  conception,  we 
must  view  the  first  cervical  nerve  as  only  one  of  a  group  of 
four  cervical  nerves  which  act  in  harmony. 

Cervical  Plexus. — The  first  four  cervical  nerves  are  in- 
terwoven to  form  a  plexus.  Each  distributive  branch  from 
this  plexus  probably  contains  some  communicating  fibres  from 
the  four  primary  nerve  trunks.  Viewing  the  plexus  as  a 
whole,  we  find  that  its  branches  are  distributed  according  to 


2i8  PRINCIPLES  OF  OSTEOPATHY. 

Hilton's  law.  They  innervate  the  skin  of  the  neck  as  low  as 
the  fifth  cervical  spine  posteriorly,  then  obliquely  forward  as 
low  as  the  sterno-clavicular  articulation  anteriorly,  and  the 
acromio-clavicular  articulation  laterally.  The  skin  of  the  pos- 
terior surface  of  the  cranium  and  the  ear  receives  sensory 
fibres  from  this  plexus.  These  are  the  gross  points  to  be  re- 
membered concerning  cutaneous  sensory  distribution  from  this 
plexus.  The  muscles  under  this  cutaneous  area  all  receive  mo- 
tor fibres  from  the  first  four  cervical  nerves. 

Anatomists  divide  the  cervical  nerves  into  anterior  and 
posterior  divisions,  then  describe  these  separately.  This  is  an 
artificial  division  which  does  not  serve  any  useful  purpose  for 
us.  It  multiplies  detail  without  giving  an  adequate  concep- 
tion of  the  real  character  of  the  whole  nerve.  When  you  study 
the  ultimate  distribution  of  the  anterior  division  of  a  nerve 
forming  the  cervical  plexus,  do  not  fail  to  remember  that  the 
ultimate  distribution  of  the  posterior  division  is  a  part  of  the 
same  nerve.  If  the  anterior  division  communicates  with  a 
sympathetic  ganglion,  the  posterior  division  receives  impulses 
from  and  sends  impulses  to  this  ganglion.  If  the  anterior  di- 
vision communicates  with  the  vagus  and  hypoglossal  nerves, 
the  posterior  division  is  a  party  to  this  communication,  and 
in  all  ways  benefits  or  suffers  by  it  according  to  the  number 
and  intensity  of  the  stimuli  applied  at  any  point  along  the 
course  of  either  nerve. 

This  upper  portion  of  the  neck  is  the  most  flexible  part 
of  the  whole  spinal  column.  It  is  subjected  to  more  changes 
of  temperature  and  more  strains  or  twists  than  other  portions 
of  the  spine.  The  constant  effort  to  save  the  head  from  injury 
puts  a  severe  tax  upon  the  activity  of  the  muscles  moving  this 
portion  of  the  spinal  column.  Subluxations  of  the  atlas  and 
third  cervical  are  quite  frequent.  Muscular  lesions,  contrac- 
tions, are  found  here  in  connection  with  functional  disorders 
of  many  kinds  located  in  the  brain,  eyes,  ears,  nose,  mouth 
or  throat.  Almost  invariably  a  relaxation  of  these  contrac- 
tions will  be  a  necessary  step  in  relieving  disorders  in  the  areas 
named. 

Intensity     of     Reflexes. — Individuals  differ  greatly  in 


PRINCIPLES  OF  OSTEOPATHY.  219 

the  intensity  of  their  reflexes.  Anatomatically  considered,  the 
connections  between  the  sympathetic  and  cerebro-spinal  sys- 
tems are  alike  in  all  individuals,  but  physiologically  consid- 
ered, there  is  a  vast  difference  in  the  degree  of  independent 
functioning  of  these  systems.  Patients  will  be  found  whose 
symptoms  and  lesions  do  not  show  any  marked  tendency  to- 
ward reflexing  impulses  from  one  system  to  the  other.  The 
sympathetic  nerve  cells  may  be  so  vigorous  that  severe  lesions 
affecting  cerebro-spinal  nerves  do  not  in  the  least  disturb  the 
rhythm  of  the  sympathetic  system.  Likewise  severe  func- 
tional disturbances  may  exist  in  the  area  of  the  sympathetic 
control  without  causing  very  definite  conscious  sensations. 

The  Spinal  Accessory. — The  sterno-cleido-mastoid  and 
trapezius  muscles  are  innervated  by  the  spinal  accessory.  This 
nerve  arises  from  the  spinal  cord  as  low  as  the  sixth  cervical, 
therefore,  its  impulses  are  co-ordinated  with  the  cervical  plexus 
in  the  area  of  its  normal  control. 

The  Phrenic  Nerve — Hiccough. — The  phrenic  nerve  is 
the  motor  nerve  from  the  cervical  plexus.  It  innervates  the 
diaphragm.  It  is  formed  by  branches  of  the  third,  fourth  and 
fifth  cervical  nerves.  The  position  of  this  nerve  in  its  course 
along  the  anterior  surface  of  the  scalenus  anticus,  makes  it 
convenient  to  apply  direct  inhibitory  pressure  over  the  nerve 
trunk.  This  pressure  has  a  restraining  influence  over  the  im- 
pulses traveling  to  the  diaphragm ;  therefore,  we  inhibit  to  stop 
hiccough.  We  have  treated  cases  in  which  inhibition  was  of 
no  avail.  In  such  cases  a  strong  movement  of  the  head  and 
first  three  cervical  vertebrae,  as  a  solid  lever,  to  secure  rota- 
tion and  relaxation  between  the  third  and  fourth  cervical  verte- 
brae may  give  good  results.  Since  hiccough  is  a  reflex  due 
to  stimulation  of  sensory  nerves,  especially  the  pneumo- 
gastric,  it  should  not  be  expected  that  inhibition  of  the  motor 
nerve,  phrenic,  would  entirely  stop  hiccoughs  while  the  sen- 
sory stimulation  is  continued.  Clinically,  we  find  that  inhi- 
bition of  the  phrenic  nerve  is  sufficient  to  stop  the  ordinary  case 
of  hiccoughs.  Therefore,  we  call  the  area  over  the  course  of 
the  phrenic  nerve,  as  it  crosses  the  scalenus  anticus  muscle 


220  PKINCIPLES  OF  OSTEOPATHY. 

opposite  the  fifth  cervical  transverse  process,  the  "center  for 
hiccoughs."     See  Fig  165. 

The  Tapezius  and  Splenius  Capitis  et  Colli  Muscles. — 
The  cervical  plexus  communicates  with  the  brachial  plexus; 
therefore  we  expect  that  those  large  muscles,  such  as  the  tra- 
pezius  and  splenius,  which  are  innervated  by  nerves  from  seg- 
ments of  the  spinal  cord,  at  various  levels,  will  transmit  by 
their  action  the  influence  reflexed  to  them  at  any  point  of  their 
serial  innervation.  The  spinal  accessory  innervates  a  large 
part  of  the  cervical  fibres  of  the  trapezius.  The  third  and 
fourth  cervical  nerves  send  branches  to  this  muscle.  There- 
fore any  distrubance  along  the  course  of  these  nerves,  or  along 
the  course  of  other  nerves  in  close  central  connection  with  them 
which  may  cause  abnormal  contraction  of  the  trapezius,  will 
influence,  more  or  less,  all  the  points  of  attachment  of  that 
muscle.  The  trapezius  is  seldom  abnormally  contracted.  Any 
lessening  in  the  normal  range  of  its  action  is  quickly  noted  by 
the  patient.  The  contractured  condition  is  easily  removed  by 
a  willed  action.  We  use  the  trapezius  muscle  as  a  means  of 
transmitting  power  to  various  portions  of  the  spinal  column, 
i.  e.,  in  our  efforts  to  move  one  or  more  vertebrae. 

Vaso-motion,  Head,  Face  and  Neck. — The  superior  cer- 
vical ganglion  communicates  with  the  first  four  cervical  nerves, 
therefore  the  area  over  the  spines  of  the  first  four  cervical  ver- 
tebrae is  called  a  vaso-motor  center  for  the  head,  face  and  neck. 

Affections  of  the  Cervical  Nerves. — These  upper  cer- 
vical nerves  are  seldom  paralyzed.  Paralysis  in  this  region 
would  stop  the  action  of  the  diaphragm.  Neuralgia  may  af- 
fect the  nerves  of  this  group.  Spasmodic  contraction  of  the 
muscles  innervated  from  this  area  is  not  uncommon. 

Brachial  Plexus. — The  four  lower  cervical  nerves  arise 
from  the  cervical  enlargement  of  the  cord  and  form  the  bra- 
chial plexus  with  their  anterior  divisions,  while  their  posterior 
divisions  supply  motor  fibres  to  muscles  on  the  sides  and  back 
of  the  neck,  and  sensory  fibres  to  the  skin  over  these  muscles. 
The  anterior  division  of  the  first  dorsal  nerve  forms  a  part 
of  the  brachial  plexus. 


PRINCIPLES  OF  OSTEOPATHY. 


Fig.  62.— Surface  marking  of  the  brachial  plexus. 


222  PKINCIPLES  OF  OSTEOPATHY. 

Figure  62  illustrates  the  superficial  area  in  which  the 
reflexes  from  the  skin  and  muscles  of  the  arm  are  manifested. 
Subluxations,  or  muscular  contractions,  in  this  area  may  af- 
fect one  or  more  branches  of  this  plexus. 

Affections  of  the  Brachial  Nerves. — Neuralgia,  paraly- 
sis or  spasm  may  affect  the  area  innervated  by  this  group. 
Cervico-brachial  neuralgia  is  quite  common.  A  lesion  will 
usually  be  found  affecting  the  painful  nerve  at  its  point  of 
exit  from  the  spinal  column.  Paralysis  rarely  affects  this 
plexus  independently  of  the  nerves  leaving  the  cord  at  a  lower 
level.  Spasm  is  represented  by  such  a  condition  as  writer's 
cramp. 

Lesions  causing  cramp  or  neuralgia  may  be  located  at 
the  point  of  exit  of  the  nerve  from  the  spinal  column,  but  the 
clot  or  other  pressure  causing  paralysis  is  usually  located  in 
the  brain.  Paralysis  of  the  brachial  plexus  is  a  part  of  a  hem- 
iplegia;  it  does  not  occur  independently  of  the  more  general 
condition.  Paralysis  of  certain  groups  of  muscles  of  the  arm, 
forearm  or  hand  can  usually  be  traced  to  the  direct  injury  of 
individual  nerve  trunks  in  the  arm. 

Hemiparesis  Below  Fifth  Cervical  Vertebra. — Figures 
63,  64  and  65  illustrate  the  results  of  pressure  upon  the  spinal 
cord  at  a  point  between  the  fourth  and  fifth  cervical  vertebrae. 
The  child  was  not  very  strong  at  the  time  of  the  injury.  A 
slight  fall,  while  playing,  subluxated  the  fifth  cervical.  No 
notice  was  taken  of  this  slight  fall.  The  next  day,  while  bath- 
ing the  child,  the  mother  noted  a  peculiarity  in  the  position 
of  the  shoulder.  The  arm  could  not  be  raised  above  the  head. 
The  author  examined  this  case  the  day  the  mother  discovered 
the  change  in  the  shoulder.  At  first  glance  from  the  side,  it 
appeared  to  be  a  sub-spinous  dislocation  of  the  humerus,  but 
palpation  disproved  this.  Careful  examination  showed  a  hem- 
iparesis  of  the  whole  left  side  below  the  fourth  cervical  nerve. 
None  of  the  normal  movements  were  lost,  but  it  required  the 
utmost  effort  of  the  patient  to  make  them.  Now  and  then  the 
left  toe  would  strike  the  floor  too  soon  and  slightly  trip  her. 
Palpation  of  the  fifth  cervical  vertebra  showed  a  lateral 


PRINCIPLES  OF  OSTEOPATHY. 


223 


subluxation.     The  slightest  pressure  at  this  point  caused  the 
patient  to  cry  out  with  pain. 

After  our  examination  (these  photographs  were  taken 
at  that  time)  the  child  was  taken  to  a  surgeon,  who  prescribed 
a  surgical  operation  to  stitch  the  latissimus  dorsi  to  its  proper 


Fig.  63. — Front  view  of  case  of  unilateral  paresis. 

position  on  the  lower  angle  of  the  scapula.  He  did  not  recog- 
nize the  paretic  condition  of  the  whole  left  side.  After  a 
short  time,  the  child  was  brought  to  us  for  treatment.  Our 
sole  effort  was  to  reduce  the  subluxation  of  the  fifth  cervical 
vertebra.  The  tenderness  was  so  great  that  this  was  mani- 
festly out  of  the  range  of  possibilities  with  a  delicate  child. 


224 


PRINCIPLES  OF  OSTEOPATHY. 


After  two  weeks  of  relaxing  around  this  articulation  a  di- 
rect movement  was  made  to  reduce  the  subluxation.  The 
alignment  was  perfected,  but  no  immediate  good  results  were 
noted.  A  continued  increase  in  nerve  power  has  gradually, 
in  large  measure,  overcome  the  deformity. 

Subluxation  of  the  Scapula. — The  deformity  is  the  ef- 
fect of  uneven  contraction  of  muscles.     The  latissimus  dorsi, 


FI'JJ.  64. — Side  view  of  case  of  unilateral  paresis. 

rhomboids  and  serratus  magnus  are  weakened  while  the  le- 
vator  anguli  scapuli  and  cervical  fibres  of  the  trapezius  are 
contracting  with  their  customary  power.  The  muscles  inner- 
vated by  nerves  from  above  the  lesion  are  acting  normally, 
but  their  action  is  not  resisted.  This  results  in  subluxation  of 
the  scapula. 

The  Nerve  of  Wrisberg. — A  division    of    the    first  dor- 
sal nerve  forms  the  first  intercostal  nerve.     The  inner  and 


PRINCIPLES  OF  OSTEOPATHY. 


225 


back  side  of  the  arm  receive  cutaneous  branches  from  the  first 
dorsal  nerve.  There  is  communication  between  the  cutaneous 
nerves  to  this  area  and  the  second  intercostal  nerve  by  means 
of  the  nerve  of  Wrisberg,  hence  pain  is  frequently  felt  along 


Fig.  65. — Rear  view  of  case  of  unilateral  paresis. 

the  inner  surface  of  the  arm  in  cases  of  heart  trouble,  inter- 
costal neuralgia  in  the  second  space,  or  pleurisy. 

The  Interscapular  Region. — The  division  of  the  spinal 
column  between  the  first  and  seventh  dorsal  vertebrae  is  com- 
monly called  the  interscapular  region.  It  is  an  exceedingly 
important  one.  It  is  sometimes  called  the  pulmonary  region, 
because  it  is  the  area  from  which  the  lungs  derive  many  nerves, 
Sensory  impulses  from  the  lungs  are  co-ordinated  in  this  area. 


226 


PRINCIPLES   OF  OSTEOPATHY. 


Fie.  66. — Anterior  surface  markings  of  the  lungs. 

Figure  66  illustrates  the  anterior  surface  outline  of  the 
lungs,  while  Fig.  67  shows  the  outline  on  the  posterior  sur- 
face of  the  thorax.  These  markings  were  made  on  the  surface 
according  to  physical  methods  of  diagnosis.  They  represent 
the  average  position  of  the  lungs  in  a  healthy  man. 


PRINCIPLES  OF  OSTEOPATHY. 


227 


Fig.  67. — Posterior  surface  markings  of  the  lungs. 

Lung  Center. — Figure  68  illustrates  the  lung  center 
within  which  sensory  impulses  from  the  lungs  are  co-ordi- 
nated. A  large  proportion  of  cases  of  bronchitis,  pulmonitis 
or  pleuritis  of  either  the  simple  or  bacterial  types,  are  accom- 


228  PEINCIPLES  OF  OSTEOPATHY. 

panied  by  great  sensitiveness  in  this  area.  This  sensitiveness 
is  in  the  contracted  muscles  or,  when  the  shape  of  the  thorax 
is  greatly  changed,  at  the  angles  of  the  ribs.  Subluxations 
of  ribs  or  vertebrae  in  this  area  are  sometimes  found  in  con- 
nection with  the  inflammations  above  named.  Whether  they 
are  the  cause  or  the  effect  of  the  inflammation  can  only  be  told 
by  the  history.  Because  the  two  conditions,  that  is,  inflam- 
mation in  the  thoracic  viscera  and  osseous  subluxation,  exist 
at  the  same  time  is  no  reason  for  saying  that  the  subluxation 
is  necessarily  the  cause  of  the  inflammation.  That  is  a  mere 
dogmatic  assertion  which  lacks  scientific  proof.  The  condi- 
tion might  be  just  the  opposite.  We  do  not  desire  to  confuse 
our  readers  in  the  least,  but  it  should  be  remembered  that 
before  making  a  dogmatic  statement  such  as  "disease  is  the 
result  of  anatomical  abnormalities  followed  by  physiological 
discord,"  we  should  be  certain  that  our  statement  is  not  based 
on  a  series  of  selected  coincidences.  The  old  saw:  "It's  a 
poor  rule  that  does  not  work  both  ways,"  is  decidedly  applicable 
to  nerve  reflexes. 

Cilio-spinal  Center. — Tenderness  in  this  area  is  not 
necessarily  indicative  of  physiological  disturbance  in  any  tho- 
racic viscus.  Fig.  69  indicates  two  centers.  The  one  be- 
tween the  second  and  third  dorsal  is  called  the  cilio-spinal 
center.  Detail  concerning  this  center  will  be  found  in  the 
chapter  on  The  Sympathetic  Nervous  System. 

The  fact  that  the  vaso-constrictor  fibres  to  the  cervical 
sympathetic  ganglia  leave  the  spinal  cord  below  the  second 
dorsal  vertebra  show  that  some  reflexes  from  the  head,  face 
and.  neck  may  be  co-ordinated  in  the  interscapular  region. 

Heart  Center. — The  point  between  the  fourth  and  fifth 
dorsal  spines  is  noted  as  a  heart  center.  We  have  not  found 
any  text-book  authority  for  this  statement.  Clinical  experi- 
ence leads  the  author  to  locate  a  heart  center  at  this  point. 
What  the  absolute  influence  of  this  center  is  we  do  not  know. 
From  observation  of  cases  of  angina  pectoris  it  appears  to  be 
a  sensory  and  vaso-motor  center  for  the  heart.  Stimulation 
of  this  center  by  a  quick  percussion  stroke  of  the  fingers  will 
bring  on  an  immediate  attack  of  pain  in  the  heart,  blueness 


PEIXCIPLES   OF  OSTEOPATHY. 


229 


Fig.  68. — The  lung  center. 

of  lips  and  finger  tips.  Heavy  digital  pressure  at  this  point  re- 
lieves the  pain.  Steady  extension  of  the  whole  spinal  column 
does  not  stimulate  such  cases,  but  as  the  pull  is  reduced  and 
the  vertebrae  are  drawn  closer  together,  this  point  is  fre- 


230 


PRINCIPLES   OF  OSTEOPATHY. 


Fig.  69. —  Cilio-spinal  and  heart  centers. 

quently  stimulated.  In  order  to  avoid  an  attack  after  exten- 
sion, it  is  necessary  to  lessen  the  force  of  the  pull  very  gradually 
and  evenly. 


PRINCIPLES   OF  OSTEOPATHY. 


231 


Fie-  70. — Surface  outline  of  the  heart. 

Fig.  70  illustrates  the  surface  markings  of  the  heart. 
This  organ  has  three  centers,  (i)  The  pneumogastric  nerve 
exerts  an  inhibitory  influence.  This  nerve  can  be  stimulated 
in  the  neck.  See  Fig.  166.  (2)  The  accelerator  center  in- 


232 


PRINCIPLES  OF  OSTEOPATHY. 


Fig-  7i- — Surface  outline  of  the  stomach. 

eludes  second,  third  and  fourth  dorsal.  See  Chapter  VI  on 
the  Sympathetic  Nervous  System.  (3)  Vaso-motor  and  sen- 
sory center  is  found  between  fourth  and  fifth  dorsal. 


PRINCIPLES  OF  OSTEOPATHY. 


233 


Fig.  72. — The  stomach  center. 


Stomach  Center. — The  surface  outline  of  the  stomach 
is  given  in  Fig.  71  while  its  reflex  surface  center  on  the  back 
is  indicated  in  Fig.  72.  This  center  lies  wholly  within  the 
pulmonary  area,  therefore  it  will  be  readily  noted  that  there 


234 


PRINCIPLES   OF  OSTEOPATHY. 


Fig.  73. — The  splanchnic  area. 

is  opportunity  for  much  careful  reasoning  in  order  to  deter- 
mine whether  a  lesion  between  the  first  and  seventh  dorsal 
vertebrae  is  connected  with  disturbance  of  the  lungs,  pleura, 
heart,  eyes  or  stomach.  Clinically,  we  distinguish  somewhat 


PKINCIPLES  OF  OSTEOPATHY. 


235 


Fig.    74. — Posterior   view   of   a   case  of   leukemia. 

as  follows :  A  lesion  covering  a  large  part  of  this  area  is 
probably  pulmonary.  A  lesion  in  the  lower  half  and  extending 
below  the  seventh  spine  is  probably  gastric  in  character. 
When  the  lesion  is  at  the  third  or  fourth  and  decidedly  lim- 
ited i.  e.,  the  tenderness  is  sharply  circumscribed  in  this  area, 
it  is  impossible  to  tell,  except  by  further  examination  of  the 
heart,  bronchi  and  eyes,  to  which  it  belongs.  The  experienced 
diagnostician  can  frequently  estimate  the  probable  relation  of 
a  lesion  by  his  power  of  reading  the  signs  of  disease  as  evi- 
denced by  expression,  posture  and  general  indications. 


236 


PEINCIPLES   OF   OSTEOPATHY. 


Fig-  75- — Posterior  surface  outline  of  the  liver  and  spleen  with  their 
centers    indicated. 

The  splanchnic  area  is  a  large  and  important  one.  It  is 
indicated  in  Fig.  73.  We  have  noted  in  this  photograph  the 
upper  connections  of  the  splanchnic  nerves  in  the  pulmonary 
area.  This  explains  the  high  position  occupied  by  some  re- 


PRINCIPLES   OF  OSTEOPATHY. 


237 


Fig.  76. — Side  view  of  case  of  leukemia. 

flexes  from  the  first  part  of  the  gastro-intestinal  tract.  Won- 
derful influences  can  be  secured  in  this  area,  over  circulation 
in  the  abdominal  viscera.  The  physiological  actions  gov- 
erned from  this  area  are  described  on  page  125.  (See  Great 
Splanchnics  under  the  Sympathetic  Nervous  System,  Chapter 
VI.) 

Leukemia. — To  illustrate  the  osteopathic  view  of  the 
effect  of  osseous  disorder  on  the  functional  activity  of 
viscera,  we  present  a  series  of  three  photographs,  Figs.  74, 


238 


PRINCIPLES   OF  OSTEOPATHY. 


FiR-  77- — 'Anterior  view  of  case  of  leukemia. 

76  and  77,  of  a  case  of  leukemia  showing  the  condition  of  the 
spine  in  the  splenic  area.  The  marked  limited  kyphosis  in 
connection  with  the  enlargement  of  the  spleen  is  a  striking 
example  of  the  relation  existing  between  a  viscus  and  its 
center.  This  case  has  been  in  our  clinic  only  a  short  time, 
two  weeks,  therefore  we  cannot  tell  what  the  effect  of  the 
treatment  will  be.  It  is  an  extreme  case.  The  blood  exam- 
ination shows  thirty  per  cent  of  hemoglobin.  The  number  of 


PRINCIPLES   OF   OSTEOPATHY. 


239 


pis,  -g. Anterior  surface  outline  of  the  liver  and  large  intestines. 

white  blood  corpuscles  is    448,000    to    the    cubic    centimeter, 
that  is,  about  forty-four  times  the  usual  number. 

The  treatment  is  being  limited  to  the  spinal  area  involved. 
Thus  far  the  patient  notes  cessation  of  all  pain. 


240 


PKINCIPLES   OF   OSTEOPATHY. 


Fig.   79. — Center  for  large  intestine.     The  arrow  marks  point  of  close  connection 
of  cerebro-spinal  nerves  with  the  hypogastric  plexus. 

Liver  and  Spleen  Center. — The  liver  and  spleen  receive 
their  sensory  and  vaso-motor  innervation  from  the  eighth, 
ninth  and  tenth  dorsal  nerves.  The  surface  markings  and 


PRINCIPLES   OF  OSTEOPATHY. 


241 


Fig.  80. — Center  for  chills. 

center  are  indicated  by  Fig.  75.  The  liver  frequently  reflexes 
its  disturbed  sensory  influences  to  the  right  shoulder.  We 
have  noted  cases  of  gastric  disorder  or  enlarged  spleen  which 
reflexed  sensory  impressions  to  the  left  shoulder. 

Large  Intestine. — Fig.  78  pictures  the  surface  mark- 
ings of  the  liver  and  large  intestine.  These  average  normal 
outlines  should  be  thoroughly  remembered  and  used  when 


242 


PRINCIPLES   OF  OSTEOPATHY. 


Fie.   81. — Center   for   the  gall  bladder. 


making  a   physical   examination.     The   spinal   center   of   the 
large  intestine  is  indicated  by  Fig.  79. 

Small  Intestine. — The  first  portion  of  the  small  intes- 
tine, duodenum,  is  innervated  from  about  the  same  area  as 


PRINCIPLES  OF  OSTEOPATHY. 


243 


Fig.  82. — Center  for  the  ovaries.  Reflexes  from  the  ovaries  may  follow  the  ovarian 
plexus  to  the  aortic  and  reach  the  cerebro-spinal  system  at  this  point.  This 
is  true  for  the  testes  also. 

the  liver.  Fig.  80.  It  must  be  borne  in  mind  that  the 
splanchnic  area  is  a  large  one  and  comprehends  these  smaller 
centers.  Many  of  these  points  indicated  as  centers  are  the 


244 


PRINCIPLES  OF   OSTEOPATHY. 


Fig.  83. — Posterior  surface  outline  of  the  kidneys. 

areas  which  clinical  experience  has  noted  in  connection  with 
visceral  disturbance.  The  repeated  experience  of  many  cases 
gives  them  value  for  diagnostic  and  therapeutic  purposes. 


PRINCIPLES   OF  OSTEOPATHY. 


245 


Fig.   84. — End  of  the   spinal  cord.      Physiological    center    for    parturition,    defection 

and   micturition. 

Center  for  Chills. — Within  the  area  indicated  by  Fig. 
80,  there  is  a  center  usually  described  as  the  eighth  dorsal, 
which  has  received  the  name  of  "the  center  for  chills."  Our 
first  observation  of  the  action  of  this  center  was  in  connection 


246  PRINCIPLES  OF  OSTEOPATHY. 

with  a  case  of  malarial  fever.  Heavy  inhibition  of  this  area 
lessened  the  severity  of  the  chill.  By  following  this  method 
from  day  to  day,  at  the  time  of  the  onset  of  the  chill,  this  case 
was  cured.  Another  case  treated  at  the  same  time  did  not 
respond  to  this  line  of  treatment,  i.  e.,  the  cure  could  not  be 
attributed  to  this  one  mode  of  treatment.  Even  in  this  case, 
the  inhibition  gave  relief.  We  have  observed  the  effects  of  in- 
hibition of  this  center  in  many  cases  of  chill  due  to  nervous- 
ness, onset  of  La  Grippe  or  other  infectious  diseases,  and 
to  abscess  formation.  In  all  cases  the  treatment  was  dis- 
tinctly helpful  to  the  patient. 

The  Language  of  Pain. — Homeopathic  medical  prac- 
tice notes  variations  in  the  character  of  pain,  and  uses  these 
characteristics  as  indications  for  the  administration  of  special 
drugs,  as  though  a  nerve  fibre  expressed  a  language  of  pain. 
To  the  osteopathic  physician,  it  is  sufficient  that  a  nerve  ex- 
press a  disturbance  at  some  point  of  its  course.  This  cry  of 
the  nerves  calls  for  just  one  thing,  remove  the  cause.  Search 
is  made  for  this  cause  along  its  entire  course,  and  the  course 
of  its  connections. 

Osteopathic  View  of  Pathology. — Another  particular 
in  which  the  osteopathic  pathology  differs  from  other  schools 
of  medicine  is  in  the  way  we  view  varying  conditions  of  a 
viscus.  To  the  medical  practictioner,  simple  gastritis  is  a 
vastly  different  condition  from  gastric  ulcer.  To  the  mind  of 
the  osteopath,  these  conditions  differ  in  degree  not  in  kind. 
The  same  organ,  the  same  blood  supply,  the  same  nerves  are 
involved  in  both  conditions,  therefore  we  treat  these  struc- 
tures. Our  dietetic  treatment  takes  account  of  the  differing 
activity  of  the  stomach,  but  our  manipulative  treatment  does 
not. 

We  apply  this  same  method  to  all  organs.  Our  manipu- 
lative therapeutics  are  based  on  structure  more  than  on  func- 
tion. 

Center  for  Gall  Bladder. — The  gall  bladder  lies  under 
the  anterior  extremity  of  the  tenth  rib.  In  cases  of  gall 
stone  the  area  of  the  tenth  dorsal  spine  has  been  found  to  be 
sensitive.  All  of  the  structural  and  functional  changes  con- 


PRINCIPLES  OF  OSTEOPATHY.  247 

nected  with  gall  stones  have  seemed  to  center  at  this  area,  and 
along  the  tenth  rib.  Fig  81  indicates  the  center  for  the  gall 
bladder  at  the  spine. 

A  Case  Report. — On  October  2oth,  1900,  a  patient  was 
brought  to  the  free  clinic  of  the  Pacific  School  of  Osteopathy 
for  our  examination.  "The  ordinary  questions  as  to  history, 
symptoms,  etc.,  were  not  asked  until  a  thorough  physical  ex- 
amination had  been  made.  The  general  appearance  of  the 
patient  was  of  one  greatly  emaciated  by  long  illness.  There 
was  considerable  sensitiveness  at  several  points  along  the 
spinal  column,  but  no  apparent  mal-position  of  vertebrae. 
Pressure  on  a  level  with  the  head  of  the  tenth  rib,  right  side, 
caused  a  painful  sensation  along  the  entire  course  of  the  tenth 
intercostal  nerve ;  therefore  our  attention  was  called  to  that 
particular  area.  The  tenth  rib  was  found  to  be  twisted  and 
depressed,  so  that  the  upper  edge  of  the  eleventh  rib 
pressed  into  the  groove  on  the  lower  border  of  the  tenth, 
which  ordinarily  protects  the  tenth  intercostal  nerve.  Thus 
there  was  a  constant  irritation  of  that  nerve.  This  irritation 
was  reflexed  to  the  spinal  cord  and  thence  over  the  splanchnic 
nerve  to  the  gall  bladder,  liver,  stomach  and  spleen.  The 
history  of  the  case,  physical  examination  and  afterward  the 
examination  of  the  gall  stones  left  no  doubt  as  to  this  wo- 
man's trouble.  The  cause  of  the  gall  stones  was  the  irrita- 
tion of  the  tenth  intercostal  nerve  caused  by  the  slight  dis- 
placement of  the  tenth  rib." 

"Owing  to  the  length  of  time  this  irritation  had  existed, 
the  whole  sympathetic  system  seemed  to  be  excited.  Stimu- 
lation of  the  pneumogastric  nerve  caused  the  patient  to  become 
unconscious — inhibited  the  heart — hence  the  treatment  admin- 
istered was  to  raise  the  ribs,  replace  the  tenth,  inhibit  reflexes, 
and  direct  manipulation  over  the  gall  bladder." 

"The  fact  that  the  treatment,  as  directed,  acted  imme- 
diately, shows  that  it  was  logical  and  scientific." 

"We  have  no  doubt  there  are  other  causes  of  gall  stones, 
but  this  is  something  new  to  be  added  to  the  etiology  of  the 
disease.  It  does  even  more  than  establish  a  new  etiological 
factor,  it  helps  to  establish  the  claim  of  the  osteopath  to  a  dis- 


f 
248  PEINCIPLES  OF  OSTEOPATHY. 

tinctive  pathology,  and  a  system  of  therapeutics  based  on 
anatomy  and  physiology." — Vol.  IV,  page  174,  The  Osteo- 
path. 

Intestines. — The  small  intestines  are  governed  from  the 
lower  part  of  the  splanchnic  area,  ninth,  tenth,  eleventh  and 
twelfth  dorsal.  The  large  intestine  is  controlled  by  nerves 
from  the  lumbar  region.  There  is  a  segmental  distribution 
of  these  nerves  to  the  large  and  small  intestines.  This  seg- 
mental arrangement  is  exemplified  in  cases  of  diarrhoea.  If 
the  large  intestine  is  the  part  affected,  our  manipulation  is 
devoted  to  the  lumbar  region.  Reflexes  from  the  bowels  may 
be  found  at  any  point  between  the  ninth  dorsal  and  the  fourth 
sacral. 

In  five  consecutives  cases  of  appendicitis,  the  reflex  was 
located  at  the  third  and  fourth  lumbar  spines.  Fig.  79  indi- 
cates the  area  concerned  in  reflexes  from  the  large  intestine. 

Uterus. — The  position  of  the  arrow  in  Fig.  79  indi- 
cates the  point  of  apparently  close  connection  between  the 
hpyogastric  plexus  and  the  cerebro-spinal  system.  This  point 
is  frequently  the  seat  of  great  tenderness  which  is  entirely 
reflex  in  character.  All  of  the  pelvic  viscera  at  times  send 
reflexes  here.  The  uterus  more  than  any  other  pelvic  organ 
manifests  its  disturbed  condition  by  tenderness  at  this  point. 

The  uterus  is  such  a  changeable  organ  that  it  is  the  chief 
disturber  of  sympathetic  rhythm  in  a  woman's  body.  A 
change  in  its  position  causes  a  change  in  its  blood  supply  fol- 
lowed by  congestion  of  its  mucosa.  This  congested  condition 
sets  up  a  series  of  impulses  in  the  sympathetic  system  which 
may  never  reach  the  cerebro-spinal  system.  They  spend  their 
force  on  the  various  organs  governed  by  the  sympathetic  nerv- 
ous system,  the  heart,  stomach,  bowels,  etc.  Fig.  87  illus- 
trates the  difference  in  the  heart's  rhythm  in  the  same  patient. 
The  first  sphygmogram  was  taken  while  the  patient  had  con- 
siderable difficulty  in  moving  about  on  account  of  the  heart's 
very  irregular  action.  The  uterus  is  prolapsed.  Patient  has 
worn  a  stem  pessary  for  years.  When  the  patient  takes  the 
genu-pectoral  position  and  inhales  strongly,  while  pulling  up- 
ward on  the  abdominal  muscles  there  is  great  relief,  but  when 


PEINCIPLES  OF  OSTEOPATHY. 


249 


Fig.  85. — -Areas  of  the  lumbar  and  sacral  plexuses. 

the  heart  becomes  as  irregular  as  this  sphymogram  indicates, 
she  is  afraid  to  take  this  position.  After  twenty-four  to 
seventy-two  hours  of  irregular  action,  the  heart  regains  its 


250  PKINCIPLES  OF  OSTEOPATHY. 

rhythm.  The  position  of  the  uterus  becomes  changed  by  the 
moving  of  the  patient  in  bed.  The  perineum  is  badly  torn 
and  the  uterine  ligaments  are  greatly  lengthened,  hence  the 
organ  cannot  be  kept  in  one  position.  She  has  refused  opera- 
tion. 

Many  different  points  are  named  as  centers  for  the  uterus, 
but  they  all  rest  on  the  fact  that  after  the  organ  has  initiated 
a  large  number  of  impulses  in  the  sympathetic  system,  they 
may  be  passed  to  the  cerebro-spinal  system  at  any  point  of 
union  of  the  two  systems. 

Ovary  and  Testes. — These  organs  receive  their  sym- 
pathetic innervation  from  the  plexus  which  lies  on  their 
.arteries.  The  ovarian  plexus  is  given  off  from  the  aortic 
plexus  which  receives  fibres  from  as  high  as  the  eleventh  and 
twelfth  dorsal  ganglia.  Therefore  a  lesion  in  the  area  of  the 
eleventh  and  twelfth  spinal  nerves  is  frequently  in  connection 
with  the  ovaries  or  testes.  Fig.  82  indicates  the  height  of  the 
influence  of  the  aortic  plexus  through  its  direct  connection 
with  the  cerebro-spinal  system. 

Kidneys. — Fig.  83  indicates  the  surface  marking  of 
the  kidneys  and  the  junction  of  the  last  dorsal  and  first  lumbar 
vertebrae.  Lesions  of  either  the  eleventh  or  twelfth  dorsal 
may  affect  the  kidneys. 

The  reflexes  of  this  organ  may  reach  the  cerebro-spinal 
system  over  the  renal  splanchnic.  The  articulation  of  the  last 
dorsal  and  first  lumbar  allows  considerable  movement.  It  is 
probably  the  weakest  part  of  the  back.  The  area  of  the  twelfth 
dorsal  nerve  is  usually  sensitive  when  the  kidneys  are  affected. 
This  sensitiveness  may  extend  a  short  way  upward,  as  far 
as  the  tenth  dorsal. 

In  patients  whose  abdomen  is  moderately  thin,  it  is  pos- 
sible to  affect  the  renal  sympathetic  plexus  by  deep  manipu- 
lation above  the  umbilicus.  The  kidneys  lie  above  the  level 
of  the  umbilicus.  Have  the  patient  lie  in  the  dorsal  position 
with  flexed  thighs  so  as  to  relax  the  abdominal  muscles.  The 
balls  of  the  fingers  of  both  hands  should  be  pressed  deeply  into 
the  abdomen  about  two  inches  above  the  umbilicus,  then 
move  the  fingers  laterally  toward  the  kidneys.  Pressure  is 


PRINCIPLES   OF  OSTEOPATHY.  251 

thus  brought  to  bear  upon  the  renal  artery.  The  mechanical 
stimulation  of  the  renal  plexus  usually  results  in  vaso-constric- 
tion  of  renal  arteries. 

Second  Lumbar. — The  lumbar  enlargement  of  the 
spinal  cord  is  the  physiological  center  for  several  functions 
performed  in  the  pelvis.  Defecation,  micturition,  and  partu- 
rition, are  all  reflexly  controlled  at  this  point,  second  lumbar. 
The  spinal  cord  ends  at  the  lower  border  of  the  first  lumbar 
vertebra.  The  second  lumbar  vertebra  is  indicated  in  osteo- 
pathic  literature  as  a  center  for  the  three  functions  named 
above.  We  understand  by  this  that  an  injury  at  this  point 
may  involve  the  functional  activity  of  the  rectum,  bladder,  or 
uterus.  Disturbances  in  these  viscera  are  not  necessarily  man- 
ifested to  the  osteopath  by  tenderness  around  the  second  lum- 
bar vertebra.  Any  point  along  the  spinal  column  below  the 
second  lumbar  may  be  sensitive  as  a  result  of  disturbance  in 
the  pelvic  viscera.  Fig.  84. 

During  parturition  there  is  conscious  aching  along  the 
whole  lumbar  area,  thus  demonstrating  that  the  sensory  nerves 
of  the  uterus  can  reflex  their  irritation  to  all  the  lumbar 
nerves.  Injury  of  the  spinal  column  at  the  junction  of  the 
dorsal  and  lumbar  portions  may  affect  motion,  sensation  and 
nutrition  of  all  the  structures  innervated  by  the  cauda  equina. 
An  injury  below  the  second  lumbar  vertebra  will  not  have  as 
far-reaching  effect  as  an  injury  of  the  same  character  above 
that  point. 

Paraplegia. — AYhen  the  back  is  broken  at  the  dorso- 
lumbar  articulation,  paraplegia  results.  It  is  not  necessary  to 
actually  break  the  back  in  order  to  cause  paraplegia.  A  se- 
vere strain,  caused  by  a  fall  may  induce  such  an  exudate  around 
this  articulation  that  pressure  is  exerted  on  the  lumbar  en- 
largement of  the  cord.  Many  of  the  so-called  broken  backs, 
which  are  spoken  of  as  causative  of  paralegia,  are  not  broken 
at  all,  but  the  ligaments  are  badly  sprained.  The  same  con- 
dition exists  here  as  in  other  sprained  joints.  There  may  be 
marked  kyphosis,  but  this  does  not  necessarily  indicate  dis- 
location. The  paraplegic  condition  may  be  perpetuated  by 
the  pressure  of  connective  tissue  formed  in  the  repair  of  the 


252 


PRINCIPLES  OF  OSTEOPATHY. 


Fig.  86. — Center  for  the  bladder. 

injury.  This  is  especially  liable  to  follow  if  some  form  of 
manipulative  treatment  is  not  persisted  in  for  from  one  to 
three  years.  The  author  has  fortunately  been  able  to  observe 


PEINCIPLES  OF  OSTEOPATHY.  253 

the  slow  regeneration  of  nerve  tissue  following  complete  para- 
plegia as  a  result  of  injury  of  the  dorso-lumbar  articulation. 
This  case  has  been  observed  by  us  during  nearly  four  years. 
During  all  of  this  time,  she  has  received  osteopathic  treatment. 
This  method  of  treatment  was  not  begun  until  ten  months  after 
the  accident,  therefore,  synovial  adhesions  had  formed  to  such 
an  extent  in  the  joints  of  the  limbs  that  much  painful  manipu- 
lation of  these  joints  has  been  necessary. 

Following  the  accident,  there  was  motor  and  sensory 
paralysis  of  the  extremities,  bladder  and  rectum.  Control  of 
the  bladder  and  rectum  returned  after  two  months'  of  osteo- 
pathic treatment.  Sensation  and  motion  have  returned  to  the 
extremities.  There  is  deformity  as  a  result  of  the  adhesions 
formed  during  the  ten  months  previous  to  the  first  osteopathic 
manipulation.  The  patient  had  been  massaged  during  the  ten 
months  mentioned. 

Lumbar  and  Sacral  Plexuses. — From  the  nerves  of  the 
cauda  equina  are  formed  two  large  plexuses,  the  lumbar  and 
sacral,  indicated  in  Fig.  85.  The  branches  of  these  plexuses 
innervate  the  muscles  of  the  lower  extremities.  The  spinal 
area  from  which  these  plexuses  receive  their  fibres  should  be 
carefully  examined  whenever  any  difficulty  of  movement  or 
sensation  in  the  lower  extremities  is  presented. 

The  student  should  learn  the  sensory  and  motor  distri- 
bution of  each  branch  of  these  plexuses,  so  that  peripheral 
disturbance  can  be  immediately  associated  with  the  point  of 
emergence,  from  the  spinal  column,  of  the  affected  nerve  or 
nerves. 

The  Bladder. — Fig.  86  indicates  the  superficial  area  in 
which  reflexes  from  the  bladder  are  most  frequently  found. 
The  sensory  fibres  to  the  bladder  are  found  in  the  first,  second, 
third  and  fourth  sacral  nerves.  The  first  to  third  give  the 
strongest  evidence  of  sensory  disturbance.  When  the  mucous 
lining  of  the  bladder  is  congested,  these  sensory  nerves  are 
stimulated.  Motor  fibres  to  the  bladder  are  found  in  the  sec- 
ond and  third  sacral  nerves.  The  stimulation  of  the  sensory 
nerves  results  in  reflex  stimulation  of  the  motor  nerves,  which 
cause  contraction  of  the  muscular  tissue  of  the  bladder.  In- 


254  PRINCIPLES   OF   OSTEOPATHY. 

flammation  of  the  bladder  is  accompanied  by  almost  continuous 
desire  to  micturate. 

The  sacral  spinal  nerves  take  a  more  direct  and  unin- 
terrupted course  to  the  pelvic  viscera  than  do  nerves  from 
other  portions  of  the  spinal  column  to  their  respective  areas 
of  distribution. 

Inhibitory  pressure  over  the  sacral  foramina  has  a  very 
marked  effect  on  the  sensory  nerves  of  the  bladder.  This 
pressure  does  not  directly  affect  the  anterior  divisions  of  the 
sacral  nerves,  nevertheless  the  effect  is  the  same  as  though  the 
anterior  divisions  were  subjected  to  the  inhibitory  pressure. 


Sa-rrie    ««-«e.    odlZr     r-dit.  fit 
I  r  A.       f        • 


Fig.    87. — Sphygmograms    illustrating  the   effect   of   uterine   reflexes    on   the   heart. 

This  is  evidence  of  the  close  harmony  between  the  two  di- 
visions of  a  spinal  nerve.  The  inhibitory  pressure  not  only 
lessens  conscious  pain  in  the  bladder,  but  also  changes  the 
vaso-motor  conditions.  In  this  respect  it  much  resembles 
the  action  of  heat  applied  to  the  surface. 

Sphincter  Vaginae. — The  sphincters  of  the  vagina  and 
rectum  are  controlled  from  the  area  of  the  third  and  fourth 
sacral  nerves.  When  the  vulva,  vagina  or  rectum  are  highly 
sensitive,  we  usually  find  a  hyperaesthetic  area  at  the  third 
and  fourth  sacral  spines.  When  this  area  is  sensitive,  the 
point  where  the  pudic  nerve  crosses  the  ischiatic  spine  is  also 
decidedly  sensitive  to  pressure.  Fig.  88  indicates  the  super- 
ficial relation  of  the  pudic  nerve.  This  nerve  is  sensory  and 
motor  to  the  skin  and  muscles  of  the  perineum.  This  point 
will  be  found  sensitive  when  the  prostate  is  enlarged ;  in  fact, 
almost  any  disorder  of  the  male  sexual  organism  is  accompa- 
nied by  this  sensitive  condition. 


PRINCIPLES   OF  OSTEOPATHY. 


255 


Fig.  88. — Surface  marking  of  the  pudic  nerve. 

Inhibitory  movements  over  the  back  of  the  sacrum  and 
ischiatic  spine  will  result  in  relaxation  of  the  perineal  muscles. 
It  affects  spasmodic  stricture  o£  the  urethra  in  a  wonderful 


256  PEINCIPLES  OF  OSTEOPATHY. 

manner.  The  local  anaesthetic  effect  of  inhibition  is  not  so 
easily  demonstrated  in  any  other  portion  of  the  body  as  in  this 
sacral  area. 

When  the  uterus  is  turned  either  backward  or  forward, 
or  prolapsed  there  are  impulses  aroused  in  sensory  nerve  fibres 
in  the  rectum  or  bladder.  These  impulses  are  reflexed  to  the 
sacral  area,  while  those  aroused  in  the  uterus  pass  to  higher 
points  in  the  spinal  column.  Inhibition  of  this  sacral  area 
will  have  a  temporary  effect.  The  only  treatment  worth  while 
is  the  correcting  of  the  position  of  the  uterus. 

Conclusions. —  There  are  many  more  so-called  "centers" 
mentioned  by  osteopathic  writers.  We  have  not  attempted  to 
even  recapitulate  those  other  centers  which  seem  to  us  to  be 
quite  too  fanciful  for  practical  use.  The  centers  mentioned 
in  this  chapter  are  those  which  can  be  demonstrated  in  daily 
practice,  and  hence  are  used  continually,  both  as  guides  for 
diagnosis  and  as  indications  for  the  application  of  manipula- 
tive therapeutics.  No  sympathetic  spinal  centers  for  "sensa- 
tion," "motion"  or  "nutrition"  can  be  demonstrated.  These 
are  characteristics  of  nerve  fibres  in  general,  and  it  is  entirely 
misleading  to  limit  these  characteristics  to  any  one  portion  of 
the  spinal  column.  Every  osteopathic  center  should  be  capable 
of  demonstration  anatomically,  physiologically  and  clinically. 
Only  those  which  can  pass  this  test  satisfactorily  are  worthy  of 
our  consideration. 


CHAPTER  XII. 


SYMPTOMATOLOGY. 

The  various  symptoms  which  appear  as  the  result  of 
disease  in  the  different  tissues  and  organs  of  the  body,  when 
associated  in  fairly  constant  and  well  defined  ways,  have 
given  rise  to  the  use  of  names  which  designate  these  groups. 
A  discourse  on  symptoms,  symptomatology,  has  become  a 
thoroughly  recognized  department  of  medical  education. 
By  too  close  study  of  these  pictures  of  disease,  the  student 


PKINCIPLES  OF  OSTEOPATHY.  257 

feels  at  a  loss  for  a  definite  therapeutic  plan  unless  he  sees 
the  symptom  complex  which  he  has  been  taught  to  view 
as  an  entity  rather  than  as  separate  phenomena. 

The  basic  principles  of  osteopathy  do  not  lend  them- 
selves to  the  usual  conceptions  of  disease  as  set  forth  in 
the  works  on  symptomatology.  The  difference  seems  to 
be  principally  this :  the  older  systems  of  medicine  designate 
disease  according  to  the  tissues  or  organs  involved,  as, 
Diseases  of  the  Digestive  System,  of  the  Respiratory  Sys- 
tem, of  the  Circulatory  System,  etc.,  while  the  osteopath 
simplifies  this  greatly  by  considering  the  disturbance  in 
any  tissue  as  being  to  some  extent  a  manifestation  of  nerve 
disturbance,  and  therefore  is  most  concerned  with  what 
may  be  disturbing  "the  master  tissue" — nerve.  Many  of 
the  names  used  to  designate  disease  are  excellent,  since  they 
describe  with  fair  accuracy  the  state  of  the  principal  tissue 
or  organs  involved.  They  have  become  thoroughly  incor- 
porated in  the  popular  conceptions  of  disease  and  are  there- 
fore hard  to  eradicate.  They  should  not  be  allowed  to 
befog  therapeutics. 

There  is  no  doubting  the  fact  that  tissues  and  organs 
are  primarily  diseased,  but  more  often  the  disease  is  a  man- 
ifestation of  disturbance  of  the  nerve  center  or  fibres  con- 
trolling the  part  involved. 

The  Functional  Activity  of  any  Organ  or  Tissue  is  Pro- 
portional to  the  Circulation  of  Blood  Which  Nourishes  it. — 
The  more  blood,  up  to  a  point  where  pressure  interferes 
with  function,  the  more  activity.  The  blood  pressure  may 
vary  considerably  within  physiological  limits,  but  ischaemia 
or  hyperaemia  will  result  in  loss  or  perversion  of  function. 
Severe  functional  disturbances  may  accompany  these 
changes  in  circulation,  but  post  mortem  examination  does 
not  usually  demonstrate  their  existence. 

The  liver  may  take  on  a  state  of  physiological  congestion 
in  response  to  the  presence  of  food  for  digestion  when  the 
food  is  especially  difficult  of  digestion  and  more  of  it  is  in- 
gested than  the  liver  can  take  care  of.  The  physiological  con- 
gestion increases  to  a  state  of  hyperaemia  which  occasions  an 


258  PEINCIPLES   OF  OSTEOPATHY. 

internal  pressure  with  stretching  of  the  capsule  of  the  liver 
and  there  is  decrease  of  functional  activity.  This  hyper- 
aemia  may  advance  a  step  in  severity  and  some  of  the  ele- 
ments of  the  blood  pass  into  the  perivascular  tissues.  If 
drainage  is  sufficient  there  will  be  formation  of  fibrous 
tissue  at  the  expense  of  the  gland  cells.  A  slight  decrease 
in  drainage  may  cause  the  formation  of  pus,  i.  e.,  an  abscess. 
These  pathological  conditions  of  the  liver  varying  in  inten- 
sity are  due  to  changes  in  the  resistence  of  the  walls  of 
the  blood  vessels.  This  resistence  is  under  nerve  control. 
Reaction  may  therefore  be  rapid,  i.  e.,  a  normal  state  of  the 
circulation  may  be  quickly  established  as  long  as  there  is 
no  infiltration  of  perivascular  tissues.  If  new  tissue  or  pus 
is  formed  a  permanent  change  in  the  arrangement  of  the 
cell  elements  of  the  gland  takes  place  and  the  body  passes 
through  a  process  of  accommodation  to  new  internal 
conditions. 

There  are  many  cases  of  severe  functional  disturbances 
where  no  fixed  pathological  condition  has  been  reached. 
These  cases  get  well  rapidly  because  nerve  control  over 
the  muscular  coat  of  the  arteries  is  good  and  no  large 
amount  of  absorption  of  extravasated  blood  elements  is 
required. 

These  changes  in  the  liver  may  be  duplicated  in  any 
organ  or  tissue  of  the  body.  The  symptoms  in  any  case  will 
be  increase,  perversion  or  decrease  in  the  functions  of  the 
organ  or  tissue  involved  according  to  the  intensity  of 
circulatory  change.  These  changes  may  be  directly  ob- 
served in  the  tonsils  and  pharynx. 

A  hyperaemia,  congestion,  new  tissue  growth  or  ab- 
scess are  comparatively  the  same  pathological  conditions 
whether  they  exist  in  a  tonsil,  the  liver,  kidneys,  or  central 
nervous  system.  The  symptoms  in  any  instance  will  be 
the  functions  of  the  organ  or  tissue  expressed  in  a  plus  or 
minus  manner  and  accompanied  by  signs  of  pressure,  such 
as  pain  or  the  involvement  of  some  correlated  structures. 

There  does  not  appear  to  be  any  theoretical  reason  why 
the  diseases  of  the  nervous  system  should  be  any  more 


PRINCIPLES   OF  OSTEOPATHY.  259 

difficult  to  treat  than  those  of  any  other  tissue.  In  fact 
clinical  experience  proves  that  many  diseases  of  this  tissue 
yield  quickly  to  osteopathic  therapeutics. 

The  functions  of  the  nervous  system  are  dependent  on 
the  state  of  the  circulation  of  the  blood  in  that  system  al- 
though at  the  same  time  the  control  of  the  circulation 
resides  in  the  nerve  elements.  With  this  nicely  balanced 
condition  of  circulatory  and  nervous  systems,  subject  to 
the  effects  of  accident,  environment  and  fatigue,  it  is  aston- 
ishing disease  does  not  more  often  become  established. 

The  functions  of  the  spinal  cord  are,  (i)  to  conduct 
sensory  impulses  to  and  motor  impulses  from  the  brain; 
(2)  reflex  action;  (3)  contains  centers  which  govern  nervous 
action  in  tissues  directly  under  the  control  of  the  sympa- 
thetic ;  (4)  governs  nutrition  in  all  parts,  supplied  by  its 
nerves. 

The  functions  of  the  spinal  cord  will  vary  according 
to  the  same  law  stated  with  respect  to  the  liver,  i.  e.,  the 
functional  activity  of  an  organ  or  tissue  is  proportional  to 
the  circulation  of  blood  which  nourishes  it.  Since  nervous 
tissue  is  in  supreme  control  any  change  in  its  nutrition 
may  manifest  symptoms  not  only  attributable  to  its  func- 
tions of  motory  and  sensory  conduction  but  organs  and 
tissues  in  any  portion  of  the  body  may  manifest  distur- 
bance of  their  own  functions  not  due  to  their  involve- 
ment but  to  the  disturbed  condition  of  their  governing 
nerves. 

With  this  comprehensive  view  of  disease  conditions  it 
is  possible  to  conceive  of  any  disease  of  any  organ  or 
tissue  being  due  to  a  change  of  circulation  in  some  portion 
of  the  central  nervous  system  or  its  distributing  system  of 
nerves.  In  other  words  we  may  say  there  are  none  but 
nervous  diseases.  In  this  sense  every  physician  should 
become  a  specialist  in  nervous  diseases.  This  does  not 
mean  that  all  diseases  are  of  nervous  origin,  or  should  be 
treated  from  that  standpoint,  but  it  does  mean  that  the 
study  of  symptoms  should  begin  with  a  comprehensive 
understanding  of  the  functions  of  nervous  tissue  and  its 


26o  PRINCIPLES  OF  OSTEOPATHY. 

control  of  all  the  activities  of  the  body.  It  is  essential  in 
diagnosis  that  we  determine  the  location  of  the  disturbance 
and  its  cause.  This  is  the  first  step  towards  a  cure.  The 
examination  of  the  spinal  column,  on  account  of  its  rela- 
tion to  the  spinal  cord  should  be  made  first. 

Since  we  cannot  demonstrate  by  post  mortem  examin- 
ation the  existence  of  hyperaemic  conditions  of  the  spinal 
cord,  some  clinicians  think  any  reference  to  these  states  of 
the  circulation  which  hang  in  the  balance  between  a  physio- 
logical and  a  pathological  condition  are  but  transcendental 
theories.  The  spinal  cord,  being  so  completely  beyond  direct 
examination  in  the  ordinary  condition  we  are  compelled  to 
judge  of  its  involvement  by  the  signs  of  its  disturbed 
functions.  Those  pathological  conditions  of  the  spinal  cord 
which  are  demonstrable  by  post  mortem  show  changes  com- 
parable to  degrees  of  congestion  and  inflammation  in  other 
tissues.  Myelitis  is  comparable  to  tonsilitis.  Both  are 
inflamed  conditions,  but  differing  enormously  in  their  ef- 
fects on  account  of  the  vast  difference  in  functions  of  the 
tonsils  and  the  nervous  system. 

The  causes  of  myelitis  are  of  many  kinds.  Violence, 
either  as  a  direct  bruise  or  concussion ;  excessive  con- 
traction of  the  spinal  muscles  either  in  lifting  or  as  an 
effort  to  keep  from  falling;  exposure  to  cold;  functional 
overaction  of  the  cord  due  to  peripheral  stimulation,  i.  e., 
as  a  result  of  sexual  excess,  the  myelitis  being  established 
at  the  point  which  gives  origin  to  the  nerves  which  are 
stimulated ;  toxic  conditions  of  the  blood,  such  as  some- 
times follow  typhoid,  malaria  or  diphtheria;  also  as  result 
of  fatigue  products;  poisons  introduced  such  as  alcohol, 
irritation  and  inflammation  of  viscera  are  mentioned  by 
various  authors  of  text  books  on  nervous  diseases.  If 
causes  such  as  those  mentioned  can  produce  either  acute 
or  chronic  inflammation  of  the  spinal  cord  with  consequent 
destruction  of  tissue,  it  requires  no  stretch  of  the  imagin- 
ation to  conceive  of  lesser  degrees  of  congestion  resulting 
from  the  same  but  less  intensive  causes. 

Violence  either  extrinic  or  intrinsic,  i.  e.,  applied  from 


PKIXCIPLES  OF  OSTEOPATHY.  261 

without  or  as  an  excessive  muscular  contraction  is  a  prolific 
cause  of  primary  structural  lesions.  The  violence  may  be  so 
intense  that  the  structure  is  greatly  injured  and  a  congestion 
of  the  spinal  cord  will  result.  Examination  of  the  injured 
part  will  show  swelling,  muscular  tension,  pain,  heat  and 
osseous  deformity.  In  case  the  injury  is  severe  enough  to 
cause  all  these  symptoms,  the  congestion  of  the  spinal  cord 
will  be  evinced  by  various  signs  of  disturbance  of  the  func- 
tions of  the  structures.  The  intensity  and  extent  of  the  symp- 
toms depends  on  the  area  and  degree  of  congestion.  After 
the  congestion  is  established  in  the  spinal  cord,  it  usually  af- 
fects the  body  profoundly  and  recuperation  is  practically  al- 
ways accomplished  by  loss  of  function  in  some  degree.  Nerv- 
ous tissue  being  so  highly  organized  structural  loss  is  not 
easily  compensated  for  and  therefore  the  results  of  inflam- 
mation in  any  portion  of  it  arouses  our  fears.  If  the  same 
symptoms,  swelling,  muscular  tension,  pain,  heat  and  de- 
formity should  appear  in  any  joint  other  than  those  of  the 
spinal  area,  physicians  of  all  schools  of  medicine  would  prob- 
ably apply  hot  or  cold  applications,  elevation  of  the  joint, 
compression  and  manipulation.  When  these  symptoms  ap- 
pear in  the  spinal  articulations  with  paralysis  due  to  joint  in- 
jury, it  is  seldom  the  condition  is  viewed  or  treated  in  the 
same  manner  as  the  more  peripherally  placed  articulations. 
The  symptoms  of  profound  involvement  of  the  nervous  sys- 
tem seem  to  crowd  all  others  into  the  background  and 
hence  the  congestion  is  left  to  work  destruction  without 
hindrance.  The  fact  that  the  nervous  system  is  seriously  in- 
volved should  lead  the  physician  to  concentrate  his  remedial 
measures  at  the  point  of  injury.  The  lesion  is  primary 
and  the  congestion  which  is  to  a  great  extent  established 
for  repairative  purposes  should  be  kept  subdued  if  pos- 
sible. A  sprained  spinal  articulation  is  in  no  wise  dif- 
ferent from  a  sprained  ankle,  except  that  the  swelling 
which  accompanies  the  former  is  in  a  vital  area  and  its 
pressure  is  profound  and  far  reaching  in  its  effects.  In- 
juries of  the  spinal  articulations  may  not  be  so  severe  as 
to  cause  congestion  and  inflammation  of  the  spinal  cord, 


262  PRINCIPLES   OF   OSTEOPATHY. 

but  may  occasion  an  hyperaemia  which  affects  its  func- 
tions of  visceral  and  vaso  motor  control.  In  such  an 
instance  the  symptoms  noted  are  not  spinal  but  visceral 
and  circulatory ;  in  fact  the  spinal  condition  may  be  entirely 
overlooked  being  so  thoroughly  overshadowed  by  the  peri- 
pherally manifested  symptoms.  These  conditions  of  vis- 
ceral disease  are  purely  of  spinal  origin  and  must  be  treated 
accordingly.  The  lesion  is  spinal,  structural  in  character, 
the  primary  cause  of  visceral  disorder  just  as  certainly  as 
myelitis  causes  paralysis.  In  the  light  of  these  facts  physi- 
cal examination  should  begin  at  the  spinal  column. 

Another  cause  of  myelitis,  exposure  to  cold,  was  noted. 
The  influence  of  cold  on  sensory  nerve  endings  in  the  back 
if  at  times  sufficient  to  cause  so  profound  a  condition  as 
inflammation  of  the  cord  can  surely  affect  circulation  less 
intensely  if  the  conditions  are  less  favorable.  A  less  degree 
of  spinal  engorgement  is  conceivable  and  its  effects  on  the 
functions  of  the  cord  just  as  sure  as  though  it  was  brought 
on  by  violence.  The  local  spinal  symptoms  of  muscular 
tension  with  slight  osseous  deformity  are  generally  present 
in  palpable  degree  but  the  peripherally  placed  visceral 
and  vascular  symptoms  conceal  the  true  conditions  except 
to  the  physician  who  is  trained  to  reason  from  structure  to 
function. 

If  the  peripherally  placed  sensory  endings  in  the  skin 
can  be  so  stimulated  by  temperature  change  as  to  cause 
profound  congestion  in  the  spinal  cord,  we  should  not  be 
surprised  that  functional  overaction  of  the  cord  due  to  ex- 
cessive stimulation  of  nerves  ending  in  mucous-membranes 
may  result  in  the  same  pathological  state.  Sexual  excess 
is  the  best  example  of  this.  The  irritation  and  inflammation 
of  viscera  may  at  times  occasion  profound  congestion  of 
the  cord  but  this  is  rarely  the  case.  Head's  law  is  noted  in 
all  cases  of  peripheral  irritation  affecting  the  spinal  cord. 

The  toxic  products  of  bacterial  action  in  infectious 
diseases,  food  poisons,  waste  products  due  to  fatigue,  drugs, 
etc.,  which  may  be  free  in  the  blood  stream  irritate  the 
nervous  system  centrally  and  peripherally  and  may  oc- 


PRINCIPLES   OF   OSTEOPATHY.  263 

casion  congestion  of  varying  degrees  of  severity.  The 
spinal  lesion  accompanying  such  conditions  is  an  objective 
symptom  denoting  the  point  of  greatest  irritation  and  is 
most  often  found  at  the  area  of  the  spine  in  nervous  relation 
to  the  origin  of  the  nerves  controlling  the  organ  most  con- 
cerned in  eliminating  the  toxic  material  from  the  system. 
The  rational  treatment  in  any  such  condition  would  be  to 
hasten  elimination  by  all  means  so  as  to  save  the  organ 
showing  the  most  involvement  from  injury. 

Symptomatology  viewed  in  this  manner  is  not  simply 
a  study  of  named  diseases,  but  rather  the  study  of  what 
nerves  and  blood  vessels  are  involved  in  any  diseased  con- 
dition ;  where  and  how  these  channels  of  communication 
and  exchange  may  be  disturbed.  The  whole  picture  is  one 
of  anatomy,  with  the  function  of  each  structure  borne  in 
mind.  In  a  great  commercial  enterprise  a  disturbance  in  a 
minor  department  of  the  business  may  not  reach  the 
general  manager.  This  is  not  the  case  in  the  body.  No 
disturbance  is  too  trivial  to  be  registered  by  the  nervous 
system.' 

When  the  heart  is  primarily  affected,  intra-vascular 
pressure  may  be  below  the  point  required  for  good  func- 
tioning of  the  nervous  system.  A  condition  of  anaemia  of  the 
spinal  centers  due  to  this  cause  may  be  over  looked.  Anae- 
mia on  the  one  hand  or  moderate  congestion  may  occasion 
practically  identical  symptoms.  Therefore  the  general 
condition  of  the  heart  must  be  noted  as  well  as  the  condition 
of  local  spinal  areas.  The  peripheral  symptoms  may  be  due 
entirely  to  poor  circulation. 

The  lesions,  noted  by  Osteopaths,  involving  the  spinal 
articulations  are  active  factors  in  maintaining  congestion 
however  it  may  have  originated.  Therefore  corrective 
manipulation  is  always  an  aid,  if  not  at  all  times  a  neces- 
sary factor  in  the  cure  of  the  condition.  This  does  not  mean 
that  visceral  conditions  due  to  direct  involvement  are  not 
to  be  conscientiously  attended  to.  Viewing  disease  con- 
ditions as  just  set  forth,  the  physician  can  not  help  appreci- 
ating the  fact  that  manipulation,  hygiene  and  dietetics  are 


264  PKINCIPLES   OF  OSTEOPATHY. 

required  in  order  to  assist  nature  in  correcting  structural 
and  functional  defects. 

Surgery  is  an  ever  present  aid  when  the  body  no  longer 
manifests  sufficient  power  to  react  to  simpler  means  of 
alleviation. 


CHAPTER  XIII. 


THE  GERM  THEORY  OF  DISEASE. 

The  germ  theory  of  the  causation  of  disease  has  been  so 
positively  and  persistently  advocated,  during  the  past  decade, 
that  any  theory  which  is  promulgated  contrary  to  the  popular 
view  must,  necessarily,  have  a  foundation  which  is  capable  of 
withstanding  the  assaults  of  specific  bacteriologists. 

A  large  proportion  of  the  data  used  to  support  the  germ 
theory  of  disease  may  be  utilized  to  show  that  the  final  thera- 
peutic methods  necessary  to  combat  bacterial  diseases  are 
essentially  osteopathic,  i.  e.,  natural. 

Even  those  who  have  devoted  their  lives  to  the  investi- 
gation of  the  life  and  activity  of  bacteria  do  not  agree  in  their 
conclusions  after  observing  the  same  phenomena.  This  is  an 
evidence  that  bacteriology  has  not  passed  beyond  the  stage  of 
historical  tabulation.  The  amount  of  work  done  and  the  de- 
votion of  the  workers  speak  well  for  the  scientific  spirit  of  in- 
vestigation which  has  characterized  the  progress  of  this  theory. 
The  irony  of  it  all  is  the  fact  that  with  the  heaping  of  fact 
upon  fact,  and  experience  upon  experience,  it  all  proves  that 
when  we  eat  wholesome,  nutritious  food,  in  proper  amount, 
labor  sufficiently  to  promote  a  good  circulation,  sleep  about 
one-third  of  the  time,  wear  clothing  which  does  not  hamper 
cutaneous  respiration,  drink  clean  water  and  reside  in  well 
drained  localities,  we  have  those  conditions  which  are  condu- 
cive to  a  healthy  life.  This  much  we  knew  before,  but  we 
didn't  know  it  scientifically. 

Specific  Causes — Then,  too,  bacteriology  appeals  to 
the  human  instinct  to  attribute  diseased  conditions  to  some 


PKIXCIPLES   OF   OSTEOPATHY.  265 

specific  thing.  In  times  gone  by,  disease  has  been  ascribed 
to  all  sorts  of  mythical  spirits,  cabalistic  signs,  God's  punish- 
ment, etc. 

You  will  note  by  referring  to  Chapter  II  of  this  book  that 
we  have  taken  the  broad  view — essentially  monistic  of  the 
cause  of  disease.  The  osteopath  cannot  view  disease  from 
any  other  standpoint.  We  must  not  substitute  subluxations 
or  muscular  contraction  for  bacteria  as  the  cause  of  disease.  If 
we  make  this  substitution,  we  are  open  to  as  much  criticism 
as  the  specific  bacteriologist. 

Bacteriology  as  it  stands  today  is  the  result  of  the  study 
into  the  causes  of  spontaneous  germination,  fermentation  and 
decay,  and  the  origin  of  disease.  Bacteria  are  plants  of  the 
lowest  group.  Bacteriology  includes  now,  not  only  the  study 
of  these  low  forms  of  plant  life,  but  also  some  low  forms  of 
animal  life. 

Bacteriologists  have  from  time  to  time,  classified  these 
bacteria  into  groups  according  to  form,  method  of  forming 
spores,  etc.  These  groups  are  much  disturbed  by  the  way  in 
which  the  members  change  when  grown  in  different  media. 

Conditions  which  Affect  Life. — The  first  fact  of  great 
importance  to  us  is  that  bacteria,  like  other  forms  of  plant 
life,  are  greatly  affected  for  their  good  or  ill  by  their  relations 
with  other  forms  of  energy,  light,  temperature,  etc.  It  is  as  a 
result  of  experiment  to  determine  the  conditions  best  suited 
for  life  and  growth  of  bacteria  that  we  now  understand  pro- 
cesses of  sterilization,  disinfection,  and  the  use  of  antiseptics. 
We  have  learned  to  destroy  or  modify  the  life  of  bacteria. 

The  next  great  fact  is  that  the  human  body  is  a  con- 
stantly changing  collection  of  cells  whose  molecular  constitu- 
tion is  also  varying  from  day  to  day  and  hour  to  hour.  The 
human  body  is  a  reservoir  of  energy  with  which  bacteria  come 
in  contact.  If  the  resistance  of  the  body  is  sufficiently  strong, 
the  bacteria  are  either  killed  or  reduced  in  power.  The  re- 
sistance of  the  human  body  is  changed  for  good  or  ill  ac- 
cording to  its  relations  to  other  forms  of  energy,  such  as  food, 
sunlight,  etc. 

Resistance. — We  find  that  the  intensitv  of  the  life  of 


266  PRINCIPLES  OF  OSTEOPATHY. 

bacteria  and  the  human  body  are  modified  by  their  food  supply 
and  their  environment.  This  being  true,  we  are  principally 
concerned  with  knowing  what  conditions  are  most  detrimental 
to  the  life  and  growth  of  bacteria  and  the  most  exalting  to 
the  general  resistance  of  the  body.  This  is  the  scientific  basis 
of  hygiene. 

The  human  body  possesses  certain  powers  which  are  cap- 
able of  combating  bacteria.  These  protective  powers  have 
been  recognized  and  analyzed  by  bacteriologists. 

We  wish  to  call  attention  to  the  fact  that  Dr.  A.  T.  Still 
stated,  years  ago,  the  physiological  axiom  that  a  perfect  cir- 
culation of  blood  is  requisite  for  health,  recognizing,  of  course, 
that  the  blood  must  contain  the  proper  food  elements  for  the 
nourishment  of  the  tissues. 

Immunity. — Bacteriological  researches  have  demon- 
strated this  statement  to  be  true.  We  will  note  some  of  the 
means  whereby  the  body  protects  itself  from  bacteria.  The 
term  immunity  is  applied  to  that  condition  of  the  body  which 
exists  when  specific  resistance  to  bacteria  is  exhibited. 
Hankins'  definition  of  immunity  is  as  follows :  "Immunity, 
whether  natural  or  acquired,  is  due  to  the  presence  of  sub- 
stances which  are  formed  by  the  metabolism  of  the  animal 
rather  than  that  of  the  microbe,  and  which  has  the  power  of 
destroying  the  microbes  against  which  immunity  is  possible 
or  the  products  on  which  their  pathogenic  action  depends." 
In  other  words,  immunity  exists  when  tissue  resistance  is 
strong.  Immunity  is  a  quality  of  the  body  not  of  the  bacteria. 
Immunity  is  sometimes  inherited,  a  racial  peculiarity,  or  is  ac- 
quired by  having  the  disease.  It  is  claimed  for  vaccine  virus 
that  by  causing  the  simple  condition  of  vaccinia,  the  body 
resistance  to  smallpox  is  enhanced.  Considerable  work  has 
"been  done  along  this  line,  but  it  cannot  be  said  to  be  suc- 
cessful. It  is  an  illogical  and  dangerous  method  of  building 
up  body  resistance.  Vaccination  has  a  big  task  to  prove  an 
alibi  in  connection  with  many  constitutional  conditions  fol- 
lowing hard  after  it. 

We  quote  as  follows  from  Nancrede's  Principles  of  Sur- 
gery, page  66:  "Observers  have  extracted  certain  substances 


PKIXCIPLES   OF   OSTEOPATHY.  267 

— 'defensive  proteids' — from  the  livers  and  spleens  of  ani- 
mals, capable  of  destroying  bacteria.  These  are  never  found 
in  normal  blood ;  but  when  the  febrile  state  has  supervened, 
these  substances  in  active  state  are  detectable  in  the  circu- 
lating blood.  Blood  serum  is  well  known  to  be  germicidal  in 
virtue  of  the  nucleinic  acid  it  contains,  dissolved  out  of  or 
resulting  from  the  disintegration  of  the  Phagocytic  leucocytes."" 

The  relative  immunity  of  certain  races  to  the  attack  of 
certain  diseases,  for  example,  immunity  of  the  negro  to  yellow 
fever,  may  prove  that  there  is  such  a  condition  as  inherited 
immunity,  or  it  may  simply  demonstrate  that  the  anapholes 
does  not  enjoy  the  taste  of  the  negro's  cutaneous  excretions, 
and  therefore  does  not  prey  upon  him. 

Some  persons  resist  the  attacks  of  bacteria  for  a  long  time, 
but  finally  yield.  This  condition  has  been  explained  by  the 
results  of  experiments  made  on  animals.  An  animal  which 
is  known  to  be  immune  to  a  definite  bacterium,  if  fed  on  such 
food  as  will  radically  change  the  condition  of  its  blood  will 
lose  its  immunity.  Fatigue  will  also  destroy  immunity.  Dur- 
ing and  for  some  time  after  fatigue  the  products  of  metabolism 
clog  the  tissues,  not  only  obstructing  lymphatic  circulation,  but 
depressing  the  activity  of  the  tissues,  thereby  lessening  the 
general  circulation  and  loading  the  blood  with  waste  material. 
Hence,  as  a  result  of  these  experiments  it  is  determined  that 
immunity  depends  upon  a  perfect  circulation  of  blood,  i.  e., 
blood  containing  proper  food  for  the  tissues.  Nancrede 
writes :  "The  tissues  then  can  only  maintain  their  normal  re- 
sistance by  having  an  abundant  blood  supply;  but  this  must 
move  at  a  normal  rate,  in  vessels  of  a  certain  calibre — although 
these  conditions  may  vary  within  somewhat  wide  limits — oth- 
erwise germs  will,  for  purely  physical  reasons  accumulate  in 
overwhelming  numbers.  Still  further,  if  this  blood  does  not 
move  at  a  proper  rate,  it  will  not  promptly  carry  away  the 
poisonous  products  of  cell  metabolism,  which  will  otherwise 
directly  injure  the  cells.  Again  this  poison  laden,  because 
sluggishly  moving  blood  may  incite  the  tissue  cells  to  abnormal 
metabolism  productive  of  toxic  substances,  even  in  the  ab- 


268  PEINCIPLES  OF  OSTEOPATHY. 

sence  of  germs,  which  when  absorbed  will  produce  most  seri- 
ous constitutional  effects." 

Since  it  is  clearly  recognized  that  hyperaemia  lessens  the 
resisting  power  of  the  engorged  tissue,  we  can  readily  under- 
stand how  hyperaemia  of  the  intestinal  tract  opens  the  road 
to  general  infection  of  the  body,  or  how  the  resisting  power 
of  any  exposed  structure,  such  as  the  lung  will  be  lessened. 
Therefore,  if  we  can  lessen  the  calibre  of  blood  vessels  through 
the  medium  of  vaso-motor  nerves,  the  rapidity  of  the  blood 
current  will  be  increased  and  the  resisting  power  of  the  tissues 
restored. 

The  phagocytic  action  of  some  luecocytes  and  fixed  endo- 
thelial  cells  serves  as  a  protection  to  the  body.  These  phago- 
cytes have  the  power  to  encapsulate  a  bacterium  or  spore  and 
even  in  death  set  free  nucleinic  acid  which  is  antiseptic  . 


m 


Fig.  89. — Tubercle  bacilli  in  sputum.     Photomicrograph  made  by  J.  O.  Hunt,  D.  O. 

Besides  this  power  of  a  certain  class  of  blood  corpuscles 
to  rid  the  system  of  bacteria,  the  liver,  spleen,  kidneys  ancT 
intestines  are  active  agents  in  eliminating  toxins  from  the 
body.  This  indicates  to  us  that  we  may  assist  nature  in  over- 


PKINCIPLES   OF  OSTEOPATHY.  269 

coming  bacteria  by  removing  obstructions  to  the  circulation, 
and  by  stimulating  the  eliminating  organs  of  the  body. 

It  is  a  well-known  fact  that  one  attack  of  certain  germ 
diseases  gives  comparative  immunity  to  the  individual  as  far 
as  future  attacks  of  the  same  bacteria  are  concerned.  It  is 
on  this  fact  that  vaccination  is  based.  It  is  true  that  an  attack 
of  typhoid  fever  gives  a  degree  of  immunity  to  future  attacks 
of  the  typhoid  bacilli,  but  it  also  gives  susceptibility  to  the 
attacks  of  some  other  bacilli,  i.  e.,  the  cells  learn  to  resist 
typhoid  bacilli,  but  not  tubercle  bacilli,  hence  if  we  depend 
upon  immunity  acquired  by  having  a  disease,  or  by  innocu- 
lation,  we  may  be  immune  only  in  a  special  way  not  strength- 
ened in  general  tissue  resistance. 

Specific  Treatment. — Physicians  of  all  schools  of  prac- 
tice have  been  imbued  with  the  idea  that  specific  treatment 
is  the  logical  sequence  of  the  discovery  of  bacteria.  On  this 
basis  intestinal  antiseptics  were  recommended  for  typhoid 
fever,  and  diphtheria  antitoxin  for  diphtheria.  The  antiseptic 
treatment  for  typhoid  fever  has  proved  decidedly  unsatisfac- 
tory. Drug  medication  aims  to  stimulate  cell  resistance. 
This  method  has  proved  unsatisfactory,  although  the  object 
aimed  at  is  the  right  one.  The  simple  hydriatic  measures  em- 
ployed by  the  early  empirical  hydropaths  were  so  eminently 
successful  that  water  is  now  recognized  as  the  best  means 
of  stimulating  cell  resistance.  Under  this  method  the  death 
rate  of  typhoid  fever  has  been  reduced  to  two  or  three  per 
cent. 

Diphtheria  is  the  best  example  of  the  bacteriologist's  spe- 
cific methods  of  treatment.  It  is  a  well  recognized  fact  that 
one  attack  of  this  disease  does  not  confer  immunity.  Dr.  Fer- 
dinand Hueppe,  Professor  of  Hygiene  in  the  University  of 
Prague,  a  bacteriologist,  who  has  developed  from  that  hot- 
bed of  bacteriologists,  the  Prussian  Army  Medical  Depart- 
ment, writes  as  follows  in  his  work  on  the  Principles  of  Bac- 
teriology :  "Favorable  specific  effects,  such  as  an  immunity 
against  living  parasites  and  an  habituation  to  their  poisons, 
are  often  deceptive,  if  we  fail  to  consider  sufficiently  the 
method  of  introduction  or  innoculation.  A  state  of  protection 


270  PKINCIPLES  OF  OSTEOPATHY. 

by  way  of  the  skin  may  be  present  in  cases  where  immunity 
does  not  exist  at  all  to  infection  by  way  of  the  blood  or 
brain;  it  may  be  present  for  one  side  of  the  body  or  for  one 
extremity  and  be  lacking  in  other  organs.  If  this  fact  is  for- 
gotten then  it  may  appear  as  if  the  influence  of  the  body  fluids 
were  pre-eminent,  but  in  reality  the  last  word  rests  with  the 
body  cells.  On  this  basis  Schleich  has  very  happily  attempted 
to  explain  why  diseases  like  diphtheria,  that  start  from  the 
membrane  of  the  throat,  or  that  start  in  the  lungs,  like  pneu- 
monia and  influenza,  or  from  the  intestines,  like  cholera,  con- 
fer upon  the  organism  little  or  no  immunity  from  another  at- 
tack ;  it  is  because  large  tracts  of  cells  remain  exempt  from 
the  effects  of  the  first  invasion  and  therefore  acquire  no  protec- 
ition.  It  seems  as  if,  perhaps,  toxic  properties  did  not  exist 
when  in  reality  toxic  manifestations  are  prevented  only  by 
chance.  The  alleged  non-poisonous  diphtheria  serum  itself, 
when  introduced  into  the  derma  shows  a  toxic  action  which 
manifests  itself  in  pains  and  in  swelling  of  the  joints  and  in 
the  form  of  peculiar  and  obstinate  skin  affections  at  times  like 
those  of  scarlet  fever  or  measles,  as  well  as  in  bleeding,  kid- 
ney inflammation  and  paralysis,  and  it  is  very  doubtful  whether 
the  list  of  possible  injuries  is  yet  exhausted,  for  perhaps  other 
mischievous  effects  may  come  to  light  with  other  methods  of 
use.  Occasionally  marked  degeneration  of  heart,  kidney  and 
liver  are  witnessed  immediately  after  the  injection  of  the  diph- 
theria serum ;  and  this  fact  shows  clearly  that  in  the  use  of 
this  antitoxin  a  danger  exists  of  the  same  character  as  that 
displayed  in  Buschke's  experience  with  the  tetanus  serum.  If 
the  action  of  the  serum  were  simply  antitoxic,  danger  of  this 
kind  ought  to  be  impossible.  We  have  a  paradox  of  an  anti- 
toxin producing  a  toxic  effect.  According  to  Emmerich,  ani- 
mals that  have  been  treated  with  diptheria  serum  afterwards 
succumb  more  easily  to  an  infection  with  Staphylococci  and 
Streptococci,  a  fact  that  points  also  to  the  poisonous  action 
of  the  antitoxin  upon  the  tissues.  In  man  an  acute  outbreak 
of  tuberculosis  has  been  more  than  once  observed  to  follow  a 
serum  injection." 

Several  specific  methods  of  treating  so-called  germ  dis- 


PRINCIPLES   OF  OSTEOPATHY.  271 

eases  have  flashed  on  the  horizon  of  medicine,  but  thus  far 
none  have  proved  generally  successful,  at  least,  the  cures  at- 
tributed to  them  are  not  lifted  out  of  the  realm  of  coinci- 
dence. 

As  long  as  the  fact  exists  that  many  cases  of  diphtheria 
get  well  under  osteopathic  treatment,  which  is  addressed  pri- 
marily to  increasing  tissue  resistance  by  maintaining  a  perfect 
circulation  of  blood,  we  are  justified  in  using  the  manipulatory 
method,  which  is  free  from  the  dangers  attendant  on  the  ad- 
ministration of  antitoxin. 

Summary . — We  have  tried  to  show  in  this  very  gen- 
eral chapter  on  germ  diseases  that,  (i)  both  bacteria  and  the 
human  body,  being  living  organisms,  the  intensity  of  life  is 
modified  by  their  food  and  their  environment;  (2)  bacteria 
can  be  reduced  in  strength  or  killed  by  heat  or  chemicals ; 
(3)  when  the  bacteria  are  in  the  body,  the  use  of  chemicals 
cannot  be  specific,  because  the  body  cells  may  be  adversely 
affected  as  well  as  the  bacteria;  (4)  serum-therapy  is  not 
specific  because  it  also  is  not  without  danger  to  the  body 
cells ;  ( 5 )  the  resistance  of  the  body  cells  increases  under  the 
influence  of  favorable  food  and  environment.  Therefore,  those 
methods  which  enhance  general  tissue  resistance  are  the  proper 
methods  to  use  in  the  treatment  of  germ  diseases. 

The  sanitary  methods  which  are  gradually  being  evolved 
for  the  betterment  of  our  health  are  applied  to  those  condi- 
tions which  nurture  and  increase  bacteria  before  they  enter 
the  human  body.  By  decreasing  the  strength  and  number 
of  bacteria  on  the  one  side  and  increasing  the  tissue  resist- 
ance of  our  bodies  on  the  other,  we  combine  sanitation  and 
hygiene  in  the  most  successful  manner. 

Mankind  must  not  depend  on  osteopathy  or  any  other 
system  of  medicine  to  guard  him  from  the  inroads  of  disease. 
True,  we  can  ofttimes  find  a  structural  defect  which  has  a 
bad  effect  on  some  particular  function,  but  it  is  not  sufficient 
to  remove  this  defect  and  leave  the  patient  to  feel  that  he  has 
no  active  part  to  perform.  The  only  kind  of  inoculation  we 
advocate  is  that  which  inculcates  the  idea  of  personal  respon- 
sibility for  disease.  We  quote  again  from  Hueppe :  "If  a 


272  PEINCIPLES  OF  OSTEOPATHY. 

person  contracts  a  bacterial  disease,  tuberculosis  for  example, 
then,  according  to  Koch,  only  the  tubercular  bacillus  can  be 
held  responsible.  It  is  just  this  belief  that  has  made  the 
science  of  bacteriology  so  popular  in  the  eyes  of  the  unreflect- 
ing multitude  and  of  many  easy-going  physicians.  We  need  no 
longer,  it  is  supposed,  be  solicitous  about  our  own  mistakes 
and  peccadilloes.  Come  what  may,  we  are  morally  protected, 
and,  secure  in  the  consciousness  of  our  individual  merit,  we 
now  lay  all  responsibility  upon  'the  bacteria'  as  formerly  upon 
'catching  cold.'  A  fatal  blow  is  dealt  to  these  self-deceptions 
and  illusions  by  simply  pointing  to  the  fact  that  bacteria  pro- 
voke fermentation  only  when  they  come  in  contact  with  fer- 
mentable substances  under  proper  conditions,  and  produce  ill- 
nesses and  disease  only  when  predisposition  towards  disease 
exists.  Such  liabilities  of  predisposition,  we  may  either  in- 
herit from  others  or  acquire  by  faults  of  our  own.  When  no 
susceptibility  to  disease  exists,  we  may  harbor  the  bacillus 
with  impunity.  We  should,  then,  revile  the  malicious  bacteria 
no  longer,  but  take  ourselves  to  task  and  mend  our  ways.  Not 
that,  some  measures  of  reform  having  been  effected,  we  should 
behave  ourselvse  irrationally  for  eleven  months  in  the  year, 
then  go  to  a  medical  Tetzel  and  have  prescribed  as  indulgence 
a  four  weeks'  sojourn  at  a  watering  place.  It  is  better  for  the 
majority  of  men  to  put  themselves,  through  sensible  ways  of 
living,  into  such  a  condition  that  bacteria  can  get  no  lodgment 
in  their  systems.  This,  in  a  few  words,  is  the  practical  lesson 
of  bacteriological  discoveries,  Koch  to  the  contrary  notwith- 
standing. It  is  the  less  comfortable  doctrine,  but  it  is  scien- 
tifically more  nearly  correct  than  the  other." 

The  purpose  of  this  chapter  will  be  amply  fulfilled  if  it 
arouses  the  reader  to  pursue  investigations,  and  study  along 
the  lines  her®  laid  down.  We  have  not  considered  it  worth 
while  to  recount  here  a  long  list  of  cases  of  bacterial  diseases 
success fuly  treated  by  osteopathic  methods. 

We  may  sum  up  our  conclusions  as  follows :  The  blood 
contains  the  ingredients  for  overcoming  bacteria.  In  order 
to  afford  the  blood  the  greatest  opportunity  to  exercise  its 
antiseptic  qualities,  it  must  circulate  freely  and  be  fed  properly. 


PEINCIPLES  OF   OSTEOPATHY.  273 

The  heart  is  controlled  by  nerves  from  a  definite  center, 
which  is  in  connection  with  the  surface.  Large  vascular  areas 
are  in  close  central  nervous  connection  with  the  surface  of 
the  body,  therefore,  the  anatomical  and  physiological  factors 
are  present  whereby  we  may  influence  circulation  by  manipu- 
lation or  other  therapeutic  methods  affecting  the  surface  of 
the  body. 

The  eliminating  powers  of  the  kidneys  and  intestines 
can  be  effected  by  therapeutic  methods  applied  to  the  skin  and 
mucous  membranes. 

Therefore  osteopathy  treats  germ  diseases  by  removing 
obstructions  to  the  circulation  of  the  blood  and  to  the  elimi- 
nating power  of  the  emunctories,  and  by  attention  to  sanita- 
tion, diet  and  hygiene. 


CHAPTER  XIV. 


ACCOMMODATION  AND  COMPENSATION. 

Examination  of  patients  frequently  reveals  the  results  of 
accidents  or  disease  which  do  not  appear  to  have  any  present 
deleterious  influence  on  their  health.  It  is  always  necessary 
for  the  physician  to  estimate  the  relations  which  these  changes 
have,  in  the  past,  borne  to  the  general  health,  or  may  at  pres- 
ent, be  liable  to  exert  under  known  conditions  of  climate,  diet 
and  environment. 

Definition. — In  speaking  of  structural  and  functional 
changes,  we  use  the  words  accommodation  or  compensation. 
Accommodation  means  "adaptation  or  adjustment;"  histo- 
logically,  "the  occurrence  of  changes  in  the  morphology  and 
function  of  cells  following  changed  conditions."  Compensa- 
tion means,  "to  make  up  for,"  "to  counterbalance,"  "that 
which  makes  good  the  lack  or  variation  of  something  else." 
The  examples  of  accommodation  and  compensation  are  very 
numerous  and  it  is  necessary  for  the  physician  to  be  able  to 
recognize  the  cases  in  which  the  body  has  exercised,  or  may, 
10  with  proper  assistance,  exercise  this  power  to  a  great  degree. 
It  is  sometimes  said  that  disease  is  an  effort  of  the  body  to 


274  PRINCIPLES  OF  OSTEOPATHY. 

accommodate  itself  to  new  conditions,  that  is,  changes  in  the 
quantity  and  quality  of  stimuli  occasioned  by  variations  in 
climate,  diet,  environment  or  accident. 

Osteopathy  apparently  originated  from  the  fact  that  struc- 
ture affects  function.  With  this  as  a  basis,  all  examinations 
are  made  from  the  structural  standpoint  and  therefore  if  we 
follow  this  method  too  literally  we  are  apt  to  overlook  the 
fact  that  the  cells  of  our  bodies  have  the  power  of  accommo- 
dating themselves  to  very  pronounced  changes  in  all  those 
things  which  are  considered  essential  to  perfect  functioning. 
Function  in  these  affected  cells  may  not  be  perfect,  measured 
by  their  former  activity,  and  yet  apparently  answer  all  the  de- 
mands made  upon  them  by  the  conscious  or  sympathetic  life  of 
the  individual.  There  may  be  other  cells,  somewhat  similar  in 
character  whose  increased  activity  can  compensate,  that  is, 
"make  good  the  lack  of"  activity  in  the  affected  cells. 

The  Spinal  Column. — The  examination  of  the  spine  fre- 
quently reveals  the  irregularities  in  its  structure.  Disturbed 
function  in  some  viscus  or  other  group  of  tissues  is  sometimes 
attributed  to  this  structural  variation  even  when  no  direct  nerve 
influence  over  the  affected  tissues  can  be  directly  traced  to  the 
spinal  area.  Mere  change  in  structure  cannot  warrant  us  in 
considering  it  primary  to  a  functional  disturbance  which  does 
not  exist  in  a  location  whose  control  can  be  traced  to  it.  The 
effort  on  our  part  to  always  connect  structure  with  function, 
having  the  relations  of  cause  and  effect,  sometimes  leads  to 
very  far-fetched  reasoning.  It  is  necessary  for  us  to  decide, 
in  a  given  case,  whether  or  no  the  present  condition  of  the 
individual  is  as  good  as  it  can  be  made.  Our  decision  will 
manifest  to  the  keen  observer  whether  we  have  recognized 
the  extent  of  possible  accommodation  and  compensation. 

Curvatures  of  the  spine  present  many  phases  which  must 
be  considered  before  treatment  is  begun.  The  curvature  of 
an  old  case  of  Pott's  disease  seldom  affects  sympathetic  life 
to  the  extent  that  we  would  expect.  The  very  gradual  pro- 
gress of  this  disease  seems  to  give  ample  opportunity  for  the 
structures  in  close  relation  to  the  diseased  area  to  accommo- 
date themselves  to  the  changed  conditions.  It  is  hardly  con- 


PRINCIPLES  OF   OSTEOPATHY.  275 

ceivable  that  anyone  would  fail  to  recognize  the  accommoda- 
tion manifested  in  these  cases,  and  yet  we  have  heard  of  those 
who  advocated  forcible  straightening  of  the  spine.  The  ques- 
tion to  be  decided  is  whether  it  is  better  to  risk  life  by  forcible 
straightening  of  the  spine  or  endure  deformity  with  fair 
health.  Deformity  is  always  a  wound  in  the  self-esteem  of 
the  individual.  Many  would  risk  life  time  and  again  to  be 
rid  of  it.  It  is  this  which  gives  the  experimenting  physician 
or  surgeon  ample  opportunty  to  try  his  skill  or  his  ignorance. 
It  is  all  one  to  the  patient,  a  chance  to  be  rid  of  deformity. 

Compensatory  Curvature. — A  lateral  curvature  of  the 
spine  usually  has  two  parts,  the  primary  and  the  compensa- 
tory curve.  The  compensatory  curve  is  the  effort  to  maintain 
the  erect  position,  that  is,  have  the  shoulders  and  hips  level. 
The  physician  must  determine  which  is  primary  and  which  is 
compensatory. 

When  the  hip  is  dislocated  or  any  condition  exists  which 
shortens  one  leg,  the  spinal  column  is  curved  to  compensate 
for  this  reduced  length.  It  would  be  useless  to  treat  a  com- 
pensatory spinal  curvature  without  lengthening  the  leg  by 
reducing  a  hip  dislocation  or  putting  an  extension  on  the 
shoe.  When  the  femur  is  dislocated,  all  the  thigh  and  hip 
muscles  accommodate  themselves  to  a  new  position,  then  the 
spinal  column  curves  to  let  the  pelvis  tilt  enough  to  compen- 
sate for  the  lack  of  length  in  the  extremity.  The  longer  the 
dislocation  has  existed  the  more  perfect  is  the  accommoda- 
tion and  compensation.  To  reduce  the  dislocation  we  must 
undo  the  work  of  accommodation,  that  is,  lengthen  the  muscles 
and  force  the  head  of  the  femur  into  the  acetabulum.  In 
cases  of  congenital  hip  dislocation  it  is  questionable  whether 
they  can  be  reduced  by  the  slow  osteopathic  method  of  re- 
laxing the  muscles.  Accommodation  and  compensation  are 
very  pronounced  in  these  cases.  The  acetabulum  having 
never  been  used  is  practically  non-functional.  We  have  seen 
Dr.  Lorenz  demonstrate  his  radical  method  for  the  reduction 
of  congenitatty  dislocated  hips,  but  we  are  not  able  to  give  the 
final  result  because  sufficient  time  has  not  elapsed.  Judging 
from  our  previous  personal  examination  of  some  of  the  cases 


276  PRINCIPLES  OF  OSTEOPATHY. 

he  operated  upon,  we   are  opposed  to  treating  them  osteo- 
pathically  or  otherwise.     They  were  healthy,  active  children. 

The  Extremities. — Accommodation  and  compensation 
can  be  noted  very  quickly  in  many  cases  of  injury  of  the  ex- 
tremities. A  fixed  scapulo-humeral  articulation  is  partially 
compensated  for  by  increased  mobility  of  the  scapula  on 
the  thorax.  When  the  anterior  tibial  group  of  muscles  is 
paralyzed  the  patient  compensates  for  inability  to  raise  the 
toe  by  flexing  the  thigh.  When  the  hip  joint  is  fixed  in  the 
extended  position,  the  lumbar  portion  of  the  spinal  column 
becomes  very  flexible. 

The  Thorax. — Drooping  of  the  ribs  lessens  the  antero- 
posterior  diameter,  but  increases  the  vertical  diameter.  The 
full  round  chest  of  large  capacity  is  usually  less  flexible  and 
active  than  the  small  chest.  The  question  in  each  case  is 
whether  the  thorax  is  doing  the  amount  of  work  necessary  for 
the  body. 

All  individual  spinal  lesions  must  be  judged  carefully  as 
to  their  relations  to  functional  disturbance.  The  fact  that 
spines  develop  unevenly  in  many  cases  makes  it  hard  to  de- 
fine their  exact  condition.  A  lateral  subluxation  may  exist  to 
which  the  body  has  become  accommodated.  To  reduce  this 
subluxation  might  again  subject  the  individual  to  disturbed 
function. 

Skin  and  Kidneys. — A  spinal  lesion  might  cause  a  dis- 
turbance in  the  functioning  of  the  kidneys,  decrease  of  activity, 
which  in  turn  is  compensated  for  by  increased  activity  of  the 
skin,  which  in  time  is  compensated  for  by  increased  activity 
of  the  bowels.  The  diarrhoea  in  this  case  would  be  compen- 
satory and  yet  it  is  very  difficult  for  the  physician  to  note  this 
fact.  If  therapeutic  means  were  used  to  stop  the  diarrhoea 
and  the  kidneys  or  skin  did  not  immediately  take  up  the  work 
of  elimination,  the  body  would  call  upon  the  serous  mem- 
branes and  areolar  tissue  to  take  care  of  the  surplus  liquid 
in  the  circulation.  As  a  result  there  would  be  edema  of  the 
extremities,  ascites,  pleuritic  effusion.  When  all  the  serous 
cavities,  pleura,  pericardium,  peritoneum  and  tunica  vaginalis, 
and  areolar  tissues  were  well  filled  with  liquid,  even  the 


PRINCIPLES   OF  OSTEOPATHY.  277 

cranial  and  spinal  cavities  would  be  pre-empted,  thus  destroy- 
ing the  nervous  tissue. 

The  compensating  action  which  may  take  place  between 
the  kidneys,  skin,  mucous  and  serous  membranes  is  one  which 
is  more  frequently  recognized  and  made  use  of  by  physicians 
than  any  other  example  of  the  same  power  manifested  in  the 
body.  The  fact  that  the  skin  and  kidneys  respond  to  each 
•other's  needs,  forms  the  basis  for  many  therapeutic  pro- 
cedures. Mucous  membranes  become  active  when  the  skin 
fails.  Perspiration  reduces  activity  of  the  mucous  membranes. 
Serous  membranes  cease  their  excessive  activity  when  mucous 
membranes  eliminate  freely.  The  oedema  of  areolar  tissue 
gives  way  to  activity  of  mucous  membranes.  The  physician 
must  recognize  which  is  the  diseased  tissue  and  which  is  the 
compensating  one.  The  failure  of  the  kidney  to  excrete  might 
not  be  the  fault  of  its  own  structure,  but  result  from  the  vis 
a  tergo  given  the  circulation  by  a  diseased  heart. 

The  Heart. — Compensation  by  the  heart  for  some  me- 
chanical defect  in  it,  is  the  most  interesting  subject  studied 
by  the  physician.  As  a  result  of  contraction  of  the  orifices 
of  the  heart  or  faulty  action  of  its  valves,  there  is  an  increase 
in  the  size  of  one  or  more  of  its  chambers.  This  increase  is 
at  the  expense  of  the  thickness  of  its  walls,  thus  resulting  in 
disproportion  between  the  size  of  the  cavity  of  the  ventricle 
or  auricle  and  the  amount  of  muscular  tissue  required  to 
empty  them  of  their  contents.  When  the  proportion  between 
the  cavity  and  its  walls  is  so  far  restored  that  the  heart  is 
able  to  overcome  the  stasis  of  the  blood  in  that  portion  of  the 
circulatory  apparatus  behind  the  lesion,  we  say  that  compen- 
sation exists.  The  ability  to  recognize  the  existence  of  a  heart 
lesion  is  of  great  value  to  a  physician. 

Power  of  Encysting. — In  this  western  country,  Califor- 
nia, we  have  ample  opportunity  to  witness  the  ability  of  in- 
dividuals to  do  hard,  tedious  work  after  a  considerable  por- 
tion of  the  lung  has  been  diseased  and  expectorated.  The 
nealing  which  takes  place  under  favorable  climatic  condi- 
tions, seems  to  leave  the  remainder  of  the  lung  in  perfect  func- 
tional condition.  We  have  examined  two  cases  in  which  the 


278  PRINCIPLES  OF  OSTEOPATHY. 

whole  right  lung  was  destroyed  and  the  heart  had  been  drawn 
into  the  right  half  of  the  thorax.  Both  of  these  individuals 
were  able  to  compete  with  their  more  perfect  fellows  for  a 
living  by  doing  hard  manual  labor.  One  of  these  patients 
had  a  discharging  abscess  in  the  axillary  line  between  the 
ninth  and  tenth  ribs.  This  abscess  had  discharged  continu- 
ously for  four  years.  The  patient  did  not  complain  of  a  single 
symptom  of  ill  health.  He  earned  his  living  as  a  miner. 
This  shows  how  thoroughly  the  system  may  become  accom- 
modated to  very  marked  changes  in  the  condition  of  its  tissues. 
This  abscess  was  in  the  man,  but  apparently  not  affecting  his 
functions.  Probably  the  abscess  was  walled  off  from  the 
active  body  tissues  by  a  protective  membrane  such  as  that 
which  surrounds  a  tubercle  in  the  lung  and  separates  it  from 
the  healthy  tissue. 

The  history  of  the  lodgment  of  bullets  in  various  portions 
of  the  body  demonstrates  that  what  cannot  be  thrown  off  by 
ordinary  means  may  become  encysted  and  thus  not  interfere 
with  the  activity  of  the  tissues. 


CHAPTER  XV. 


INHIBITION. 

Acceleration — Inhibition. — We  have  noted  in  the  chap- 
ter on  irritable  tissue  that  the  attributes  of  nervous  tissue  are 
irritability,  conductivity  and  trophicity.  We  may  add  to 
these  acceleration  and  inhibition.  We  do  not  use  the  terms 
stimulation  and  inhibition  as  denoting  opposite  conditions,  be- 
cause stimulation  applies  to  the  initiation  of  an  impulse.  This 
impulse  may  be  acceleratory  or  inhibitory  in  character.  We 
may  stimulate  a  nerve  whose  chief  function  is  inhibition.  An 
impulse  whether  acceleratory  or  inhibitory  in  character  is  the 
result  of  stimulation. 

All  bodily  functions  require  stimulation,  in  the  sense  we 
have  used  the  term,  i.  e.,  something  must  initiate  an  impulse 
which  is  designed  to  excite  activity.  After  this  activity  is 
started,  it  must  be  governed.  It  is  the  means  of  governing 
these  activities  we  are  interested  in  studying. 


PRINCIPLES  OF  OSTEOPATHY.  279 

It  is  not  our  aim  to  make  an  exhaustive  study  of  the  in- 
nervation  of  each  organ  in  order  to  understand  the  manner  of 
governing  activity  in  them.  Only  the  simplest  and  most  use- 
ful points  will  be  noted  here. 

Muscular  Contraction. — Muscle  may  be  stimulated  to 
contraction.  This  contraction  may  be  increased  or  decreased, 
thus  showing  that  after  the  initiatory  impulse  starts  on  its  way 
to  the  point  of  conversion  into  work  done  by  the  muscle  it  is 
accelerated,  increased,  or  inhibited,  restrained  by  certain  in- 
fluences which  we  cannot  easily  analyze.  The  contraction  and 
relaxation  phenomena  of  muscle  are  equally  important.  Vaso- 
constriction  and  vaso-dilation  are  examples  of  these  phe- 
nomena. 

Secretion. — The  activity  of  secretory  tissues  is  regu- 
lated by  some  arrangement  similar  to  that  controlling  muscu- 
lar action.  After  a  cell  becomes  active  it  is  still  under  the 
control  of  a  governing  center  which  accelerates  or  inhibits  ac- 
cording to  the  necessities  of  the  case. 

Acceleration  and  Inhibition  as  Attributes  of  Nerve 
Tissue. — Cells  are  full  of  potential  energy  which  needs  a 
stimulus  to  start  its  conversion  into  kinetic  energy.  We  may 
ask  ourselves  the  question,  Why  isn't  all  of  the  potential  energy 
converted  into  kinetic  at  one  time  or  in  response  to  a  single 
stimulus?  If  the  explosive  material  in  a  magazine  is  ignited 
it  all  explodes,  there  is  complete  conversion  of  potential  into 
kinetic  energy.  There  is  no  restraining  or  accelerating  in  this 
case.  The  element,  nitrogen,  whose  liberation  in  this  case 
causes  such  dire  results,  is  the  same  element  in  the  cells  whose 
liberation  is  noted  as  "work"  done  by  muscle  or  gland.  Why 
isn't  all  of  the  nitrogen  in  the  cells  liberated  by  a  single  stimu- 
lus as  in  the  magazine?  We  can  think  of  no  explanation  ex- 
cept that  impulses  passing  over  nerves  are  qualified  by  other 
impulses  passing  over  other  nerves,  the  two  stimuli  of  opposite 
character  thus  modifying  each  other,  or  in  some  cases,  adding 
their  forces  when  of  like  character. 

Inhibition  as  an  attribute  of  the  nervous  system  does  not 
seem  to  be  exercised  in  short  reflex  arcs,  neither  does  it  ap- 
pear to  be  exercised  by  centers  in  the  spinal  cord.  It  may  be 


280  PKINCIPLES  OF  OSTEOPATHY. 

that  a  certain  amount  of  inhibitory  influence  is  exerted 
in  these  subsidiary  centers,  but  thus  far  investigations 
demonstrate  this  attribute  to  be  possessed  by  the  brain 
cells.  Experiments  on  pithed  frogs  by  members  of  my  classes 
showed  that  stimuli,  electrical  or  mechanical,  applied  to  the 
spine  called  forth  the  fullest  possible  contraction  of  the  ex- 
tensor muscles.  Every  stimulation  excited  a  veritable  explo- 
sion of  energy.  The  spinal  cord  of  the  frog  functionates  in 
a  more  independent  manner  than  does  that  in  man,  hence  if 
inhibition  were  an  attribute  of  these  spinal  centers,  we  would 
expect  it  to  be  manifested  in  the  frog.  The  strength  of  the 
stimulus  seemed  to  have  no  qualifying  effect  on  the  strength 
of  the  contraction,  i.  e.,  weak  or  strong  stimuli  brought  forth 
a  strong  response.  Two  matches  will  not  cause  a  given  amount 
of  powder  to  explode  harder  than  will  one. 

Is  the  Work  Done,  Proportionate  to  the  Strength  of 
Stimuli? — In  therapeutics,  we  are  compelled  to  consider 
the  question :  Is  the  amount  of  work  done  by  muscle  or 
gland  proportionate  to  the  strength  or  number  of  stimuli  ?  We 
say,  Yes !  This  answer  is  made  as  a  result  of  observation  and 
experiment,  and  our  further  consideration  of  the  subject  of 
inhibition  will  be  from  this  standpoint. 

Inhibition  a  Normal  Attribute  of  the  Central  Nervous- 
System. — Inhibition  is  a  normal  restraining  influence  pos- 
sessed by  the  central  nervous  system.  When  the  osteopathic 
physician  speaks  of  inhibition,  he  means  a  therapeutic  pro- 
cedure which  exercises  a  restraining  influence  over  some  func- 
tion. This  restraining  influence  being  independent  of  that 
inhibition  which  is  an  attribute  of  the  central  nervous  system. 

Anything  which  decreases  the  number  or  strength  of  sen- 
sory impulses  reaching  a  reflex  center  is  inhibitory  in  charac- 
ter. The  medical  profession  has  made  use  of  a  large  number 
of  agents  for  this  purpose,  opium,  for  example. 

Physiological  Activity  Is  the  Result  of  Stimulation. — 
All  the  functions  of  our  body  are  initiated  by  stimuli.  It 
must  not  be  inferred  from  this  statement  that  the  author  is 
satisfied  that  life  consists  of  nothing  but  reflexes.  So  far  as 
we  can  note  the  phenomena  of  muscle  and  gland,  we  are  com- 


PRINCIPLES   OF  OSTEOPATHY.  281 

pelled  to  recognize  the  fact  that  most  of  them  are  reflexes. 
Work  done  by  muscle  and  gland  is  initiated  principally  by 
sensory  stimuli.  Excessive  sensory  stimuli  excite  increased 
work  in  muscle  and  gland,  sometimes  to  the  point  of  exhaus- 
tion. To  decrease  the  amount  of  work,  we  must  decrease  the 
number  of  stimuli.  The  stimuli  originate  at  the  periphery  of 
sensory  nerves.  Sensory  nerves  are  most  numerous  in  the 
skin,  mucous  membrane  and  muscle.  Inhibitory  influences 
must  be  applied  to  one  or  more  of  these  structures.  Skin  is 
the  surface  tissue,  richly  supplied  by  sensory  nerves,  and  un- 
der it  are  muscles  also  well  supplied  by  sensory  nerves. 

Hilton's  Law. — Hilton,  by  showing  that  the  skin,  mus- 
cles and  synovial  membrane  of  a  joint,  or  the  skin,  muscles  of 
the  abdomen  and  contents  covered  by  peritoneum  are  inner- 
vated from  the  same  segment  of  the  cord,  laid  a  foundation 
for  the  rational  use  of  inhibition  in  osteopathic  practice. 

Inhibition — Therapeutic. — Inhibition  as  a  therapeutic 
procedure  consists  in  a  steady,  digital  pressure  made  over 
some  nerve  trunk,  or  over  an  area  which  is  closely  connected 
with  a  spinal  segment  from  which  nerves  pass  to  an  internal 
viscus  which  we  desire  to  affect. 

In  order  to  explain  the  necessity  for  this  movement  and 
its  beneficial  effects,  we  must  note  the  phenomena  of  vaso- 
motion. 

How  Vaso-motor  Centers  Act. —  raso-nwtor  centers  act 
according  to  the  sum  of  the  stimuli  reaching  them  from  skin, 
muscle,  glands,  etc.  If  the  sensory  nerves  of  one  lateral  half 
of  the  body  are  stimulated,  as  by  pricking  with  needles,  the 
temperature  of  that  half  of  the  body  will  be  higher  than  the 
other,  thus  demonstrating  that  excessive  stimulation  of  sen- 
sory nerves  ends  in  vaso-dilation,  i.  e.,  loss  of  tone  of  the  mus- 
cular coat  of  the  blood  vessels.  Since  excessive,  i.  e.,  over- 
stimulation  of  sensory  nerves  in  this  experiment  causes  inhi- 
bition of  vascular  tone  and  hyperaemia  results,  we  argue  that 
an\  procedure  which  lessens  the  excessive  amount  of  stimula- 
tion passing  to  a  vaso-motor  center  will  favor  the  return  of 
vascular  tone.  Therefore  since  it  is  easily  demonstrated  that 
digital  pressure  lessens  pain  and  sensitiveness  in  the  area 


282  PRINCIPLES   OF   OSTEOPATHY. 

pressed  upon,  we  know  that  the  registering  power  of  these 
peripheral  nerves  is  decreased,  and  there  results  a  better  vas- 
cular tone  in  that  area. 

Over-stimulation  Equals  Inhibition. — If  over-stimula- 
tion results  in  inhibition  of  vascular  tone,  as  the  above  experi- 
ment seems  to  demonstrate,  then  it  appears  rational  to  de- 
crease the  stimulation  to  a  point  where  vascular  tone  is  not 
disturbed.  Digital  pressure  does  decrease  the  irritability, 
therefore,  we  may  express  ourselves  as  follows :  Inhibition  of 
sensory  nerves,  in  skin  and  muscle,  -which  are  over-stimulated 
will  favor  the  return  of  vascular  tone  in  all  areas  which  are 
supplied  with  nerves  from  the  same  segment  of  the  cord. 

Over-stimulation  of  sensory  nerves  causes  vascular  dila- 
tation. Inhibition  lessens  the  irritability  of  sensory  nerves  and 
hence  decreases  the  number  of  stimuli  reaching  the  vaso-motor 
centers,  thus  allowing  a  return  of  vascular  tone. 

The  Guide  for  the  Use  of  Inhibition. — Knowing  the 
complete  distribution  of  any  nerve  trunk,  we  may  judge  the 
condition  of  the  internal  structures,  supplied  by  one  of  its 
branches,  by  the  physiological  activity  of  surface  tissues,  sup- 
plied by  others  of  its  branches.  In  this  way  we  are  guided  as 
to  our  use  of  inhibition. 

Pathological  Changes  Which  Accompany  Over-stimu- 
lation.— If  an  individual  eats  a  hearty  meal  and  before  it  is 
digested  eats  another  and  continues  the  process,  the  stimulation 
of  the  sensory  nerves  in  the  mucosa  of  his  digestive  viscera 
results  in  a  physiological  hyperaemia  which,  under  the  cease- 
less stimulation  of  the  presence  of  food,  finally  becomes 
chronic.  The  liver  becomes  hyperaemic,  and  its  sensory  nerves 
are  stimulated  by  the  increased  amount  of  blood  present  in  the 
capillaries.  These  sensory  nerves  do  not  register  their  im- 
pressions on  the  sensorium  of  the  brain,  but  do  excite  that 
area  of  the  spinal  cord  with  which  they  are  connected  by 
means  of  the  rami-communicantes.  This  area  of  the  spinal 
cord  lies  between  the  sixth  and  tenth  dorsal  spines.  From 
this  area  nerves  pass  to  the  deep  muscles  of  the  back.  These 
muscles  are  excited  to  undue  contraction,  and  their  sensory 
nerves  are  thereby  made  sensitive.  The  capillary  circulation 


PKINCIPLES   OF  OSTEOPATHY.  283 

in  these  muscles  is  poor,  thereby  increasing  the  muscular  sen- 
sitiveness. This  muscular  sensitiveness,  or  rather  increased 
stimulation  of  the  sensory  endings  in  the  muscles  sends  a 
new  set  of  impulses  to  the  same  area  of  the  spinal  cord,  sixth 
to  the  tenth  dorsal,  and  the  cord  reflexes  them  back  to  the  sym- 
pathetic system.  Thus  a  figure  8  is  formed  with  the  union  of 
the  circles  representing  the  spinal  cord.  With  impulses  enter- 
ing the  cord  from  both  loops,  sympathetic  and  cerebro-spinal, 
the  cord  itself  becomes  hyperaemic.  The  constant  interchange 
of  reflexes  which  were  originated  by  excessive  demands  on  the 
physiological  activity  of  the  tissues  involved,  either  ends  in  a 
spasmodic  effort  of  nature  to  rid  itself  of  the  intolerable  con- 
dition by  means  of  a  "bilious  spell,"  or  the  hyperaemia  causes 
excessive  secretion  of  mucus,  hypertrophy  of  connective  tissue 
and  atrophy  of  parenchymatous  tissue.  The  bilious  spell  is 
nature's  safety  valve. 

Rational  Treatment. — After  such  a  condition,  as  we 
have  described,  is  well  established,  dieting  merely  lessens  the 
reflexes  in  the  sympathetic  portion  of  our  figure  8.  The  re- 
flexes in  the  cerebro-spinal  portion  are  still  active,  because  the 
deep  muscles  of  the  back  have  become  chronically  contracted 
and  continue  to  over-stimulate  the  sensory  nerves.  These  ce- 
rebro-spinal reflexes  still  help  to  maintain  the  hyperaemia  of 
the  spinal  cord  which  continues  to  disturb  the  rhythm  of  the 
sympathetic.  Manifestly,  the  treatment  must  consider  both 
portions  of  the  figure  of  8.  Dietetics  will  lessen  to  some  extent 
the  hyperactivity  of  the  sympathetic  loop.  Digital  pressure, 
inhibition,  will  relax  the  spinal  muscles  and  lessen  the  hyper- 
activity  of  the  cerebro-spinal  loop.  The  two  lines  of  treat- 
ment will  decrease  the  number  of  stimuli  entering  the  segment 
of  the  spinal  cord,  sixth  to  the  tenth  dorsal,  hence  there  will 
cease  to  go  out  from  that  segment  a  series  of  impulses  which 
have  tended  to  pervert  the  secretion  in  the  digestive  viscera. 

The  contraction  of  the  spinal  muscles  may  have  sub- 
luxated  a  vertebra  which  then  becomes  a  source  of  irritation. 
In  such  a  case,  a  movement  to  replace  the  vertebra  in  its  true 
relation  acts  in  the  nature  of  inhibition,  i.  e.,  it  ceases  to  cause 
excessive  stimuli  to  enter  the  spinal  cord. 


284  PKINCIPLES  OF  OSTEOPATHY. 

Digital  pressure  on  contracted  dorsal  muscles  causes  sen- 
sitiveness, i.  e.,  consciousness  of  the  fact  that  the  nerves  in 
that  region  are  abnormally  irritable.  The  sensitive  area  along 
the  spine  will  be  in  direct  central  connection  with  an  internal 
viscus  which  is  equally  if  not  more  sensitive. 

Hyperaesthesia     of     Sensory   Areas — Diagnosis. — The 

hyperaesthesia  of  sensory  areas  along  the  spine  is  of  practical 
value  for  diagnostic  and  therapeutic  purposes  when  we  know 
their  nerve  connections.  By  inhibiting  a  hypersensitive  spinal 
area,  we  set  up  a  change  in  an  area  of  low  sensibility,  i.  e.,  a 
visceral  area.  The  inhibitory  pressure  does  not  merely  deceive 
consciousness  by  lessening  the  power  of  its  informing  nerves, 
which  alone  have  power  to  stir  up  those  reflexes  which  will 
tend  to  assist  the  diseased  part  to  return  to  normal. 

Results  of  Inhibition. — We  know  that  inhibition  les- 
sens pain  in  the  area  of  conscious  sensation.  The  result  of 
daily  practice  teaches  us  this. 

Reflexes  which  are  sufficient  to  cause  pain  are  abnormal 
and  tend  to  set  up  other  reflex  actions  until  the  possibility  of 
a  return  to  normal  action  is  greatly  impaired.  Example :  In- 
flammation of  the  pleura  causes  muscular  contraction  in  the 
muscles  of  respiration ;  the  chest  is  held  immobile  and  adhesion 
of  the  pleural  surfaces  results.  Inhibition  allows  movement  of 
the  surfaces,  thus  overcoming  the  tendency  to  adhere. 

Pain  often  sets  up  activities  which  are  detrimental  to  ten- 
dencies of  reparative  reflexes. 

Inhibition  of  painful  areas  does  more  than  lessen  pain;  it 
aborts  those  impulses  which  are  the  result  of  pain,  and  sends  a 
counter  impulse  into  the  center,  which  in  a  measure,  negatives 
the  original  impulse.  If  this  were  not  so,  we  could  not  stop 
vomiting,  intestinal  peristalsis  or  uterine  colic.  We  know  that 
inhibition  of  a  sensory  area  of  the  spine  not  only  stops  pain 
in  that  area,  but  also  pain,  if  there  is  any,  in  the  viscus  which 
is  in  central  connection  with  it.  Therefore,  if  we  affect  the 
tonus  of  both  skeletal  and  involuntary  muscles,  sensation  in 
the  cerebro-spinal  and  sympathetic  systems,  we  certainly 
affect  the  calibre  of  blood  vessels  and  the  activity  of  secre- 
tory and  excretory  glands. 


PEINCIPLES  OF  OSTEOPATHY.  285 

It  is  not  too  much  to  say  that  inhibition  does  not  deceive 
consciousness  by  lessening  the  power  of  registering  nerves,  but 
does  stop  a  storm  of  reflexes  which  have  no  reparative  tend- 
ency, and  that  it  does  affect  the  area  of  low  sensibility,  as  is 
evidenced  by  a  change  in  the  condition  of  its  musculature, 
blood  supply  and  secretory  activity. 

There  are  many  osteopaths  who  contend  that  the  key-note 
of  all  manipulative  work,  according  to  osteopathic  principles, 
is  the  discovery  and  removal  of  a  "lesion,"  osseous  in  character. 
With  this  idea  carried  to  extreme,  the  author  has  no  sympathy. 
In  connection  with  this  idea  the  student  is  referred  to  the 
chapter  on  Subluxation,  page  165. 

The  Phrase  "Remove  Les'ons." — The  phrase  "Re- 
move Lesions"  is  a  good  one,  and  yet  it  is  inexact  in  many  cases. 
It  is  an  elastic  phrase  and  capable  of  many  and  varied  inter- 
pretations. Each  year  of  active  practice  adds  to  the  osteo- 
pathic idea  of  what  lesions  are.  Our  literature  contains  many 
references  to  lesions  which  are  not  mentioned  in  Dr.  Still's 
writings,  and  yet  Dr.  Still's  basic  work  has  made  the  later 
conception  possible.  Osseous  lesions  have  always  been  para- 
mount in  our  work  and  thought,  but  muscular  lesions  now 
hold  an  equal  place  and  bid  fair  to  lead  when  we  see  more 
clearly  into  the  subject. 

The  Human  Body  is  a  Vital  Mechanism. — We  say  that 
"when  the  anatomical  is  absolutely  correct,  the  physiological 
potentiates."  This  conception  is  based  on  the  statement  that 
the  human  body  is  a  machine.  The  human  body  is  vastly  more 
than  a  machine.  It  is  a  vital  mechanism,  and  the  fact  that 
it  is  vital  renders  it  susceptible  to  other  influences  besides 
mechanical,  such  as  falls,  twists,  strains,  etc.  We  may  truth- 
fully say  that  when  the  physiological  is  over  active,  the  ana- 
tomical alignment  is  disarranged.  The  principles  of  osteo- 
pathy as  they  were  first  promulgated  declared  that  a  structural 
defect  is  at  the  bottom  of  every  physiological  defect.  Struc- 
ture always  affects  function.  A  sufficient  number  of  cases 
were  found  to  give  a  foundation  of  fact  to  this  statement. 
Hasty  reasoning  tried  to  make  this  an  all-embracing  prin- 
ciple applicable  to  every  case  of  disease.  Other  schools  of 


286  PRINCIPLES  OF  OSTEOPATHY. 

medicine  have  made  similar  mistakes.  The  allopathic  school 
promulgated  the  "law  of  contraries."  The  homeopathic  school 
holds  aloft  the  "law  of  similars."  Neither  of  these  are  laws. 
A  law  is  absolute,  no  exceptions  are  tolerated.  If  there  are 
any  exceptions  to  a  so-called  law,  it  ceases  to  be  a  law. 

Structure  vs.  Function. — Structure  affects  function  and 
function  affects  structure.  Based  on  the  first  part  of  this 
sentence,  we  have  the  osteopathic  subluxation  theory.  The 
latter  half  forms  a  basis  for  a  legitimate  use  of  inhibition. 

This  phrase,  "remove  lesions,"  is  an  osteopathic  epigram. 
It  has  become  so  thoroughly  ground  into  the  mind  of  the 
student  that  he  feels  that  no  matter  what  the  case,  he  must 
find  a  mechanical  lesion  and  remove  it  in  order  to  effect  a 
cure.  This  is  continually  spoken  of  as  especially  scientific, 
and  this  feeling  throughout  the  profession  has  headed  off  care- 
ful investigation  in  other  phases  of  our  work. 

There  certainly  is  a  wide  field  for  the  rational  and  scien- 
tific use  of  inhibition  as  a  therapeutic  measure  in  the  treatment 
of  disease. 

Osteopathic  Meaning  of  Inhibition. — By  the  term  in- 
hibition, we  do  not  attempt  to  convey  any  other  meaning  than 
that  of  pressure,  applied  at  some  particular  point  on  the  surface 
of  the  body  for  the  purpose  of  lessening  the  hyperactivity  or 
hyperaesthesia  of  the  immediate  or  some  distant  part  of  the 
body.  The  inhibition  itself  does  in  some  cases  remove  what 
we  may  choose  to  call  a  lesion,  in  other  cases  it  may  make  the 
removal  of  a  lesion  possible,  but  in  the  majority  of  cases  its 
effect  is  purely  on  the  nerves,  thereby  acting  on  both  the  motor 
and  sensory  portions  of  the  reflex  arc,  lessening  muscular  con- 
traction and  pain. 

The  Scientific  Use  of  Inhibition. — It  has  been  proven 
many  times  that  the  osteopath  is  capable  of  checking  excessive 
functional  activity  in  viscera  by  the  simple  means  of  inhibiton. 
Some  would  quibble  as  to  the  cause  of  this  activity.  The 
original  stimulus  may  have  disappeared,  but  the  reflexes  which 
it  initiated  may  be  perpetuating  the  condition.  Many  cases 
have  been  treated  in  whch  no  definite  cause  or  osseous  lesion 
could  be  discovered.  Some  of  these  cases  came  under  the 


PRINCIPLES  OF  OSTEOPATHY.  287 

heading,  Indiscretions ;  others  under  purely  mental  conditions. 
These  cases  were  treated  by  inhibition  based  on  a  knowledge  of 
the  anatomy  and  physiology  of  the  parts  involved.  The  treat- 
ment was  successful.  We  are  sure  that  such  successes  are 
just  as  gratifying,  just  as  scientific,  as  are  those  in  which  the 
finding  and  reducing  of  a  subluxation  brings  the  glow  of  tri- 
umph to  the  eye  of  patient  and  physician  alike. 

Inhibition  as  a  Local  Anaesthetic. — Inhibition  is  a  local 
anaesthetic,  and  as  such  is  being  used  universally  in  the  osteo- 
pathic  profession  today.  True,  it  is  not  a  treatment  which  will 
secure  results  in  a  minute.  We  can  not  inhibit  for  five  minutes 
at  the  eighth  dorsal  spine  in  a  case  of  malarial  fever  and  expect 
to  check  the  chill.  The  chill  can  sometimes  be  controlled  as 
long  as  the  inhibition  is  maintained.  The  influence  thus  gained 
over  the  muscular  contractions  seems  to  increase  the  patient's 
resistance.  The  onset  of  the  next  chill  usually  shows  a  de- 
crease in  the  intensity  of  muscular  contraction,  and  the  duration 
is  shortened.  No  one  would  say  that  we  remove  a  physical 
lesion  by  this  treatment.  Muscular  contraction  of  the  deep 
dorsal  muscles  comes  on  with  the  chill,  but  does  not  cause  it. 
Surely  inhibition  in  this  case  works  a  nervous  change  of  a 
pronounced  character. 

Inhibition  May  Act  Without  Removing  a  Lesion. — In- 
hibition for  the  vomiting  of  pregnancy  in  no  sense  removes 
a  lesion,  and  yet  it  has  successes  to  its  credit,  surely  the  inhibit- 
ing influence  exerted  on  the  stomach  is  great,  for  it  is  able  to 
overcome  the  reflexes  from  the  pregnant  uterus. 

The  vomiting  and  purging  of  cholera  morbus  can  be  con- 
trolled by  inhibition,  and  in  this  case  there  is  probably  an 
irritant  to  the  intestinal  mucosa  in  the  form  of  indigestible 
food.  The  irritant  is  not  removed  by  the  inhibiton,  but  the 
excited  stomach  and  bowels  are  given  rest,  and  in  consequence 
are  able  to  carry  on  their  functions  properly. 

An  example  of  the  good  results  of  inhibition  is  afforded 
by  one  of  the  author's  cases.  Woman,  fifty  years  of  age,  suf- 
ered  from  diarrhcea,  two  years  duration.  Five  to  seven  bowel 
movements  daily.  No  formed  feces.  Usually  the  stools  were 
typhoid  in  character.  Uterine  fibroid  removed  prior  to  devel- 


288  PRINCIPLES  OF  OSTEOPATHY. 

opment  of  diarrhoea.  History  of  continuous  drug  treatment. 
Osteopathic  examination  did  not  reveal  any  osseous  lesion. 
There  seemed  to  be  nothing  to  lay  the  blame  upon,  except  the 
once  existent  fibroid  or  the  result  of  the  operation.  Since  no 
definite  lesion  existed,  the  treatment  was  planned  as  a  test  of 
inhibition  without  any  other  method.  At  the  end  of  three 
months  the  patient  had  but  one  movement  daily,  and  the  feces 
were  well  formed.  Pressure  and  gentle  stretching  of  the 
muscles  extending  over  the  area  between  the  eighth  dorsal  and 
fifth  lumbar  spines  constituted  the  methods  used.  From  fifteen 
to  twenty  minutes  was  the  duration  of  the  treatment  three 
times  per  week  for  two  months  and  twice  per  week  thereafter. 
In  cholelithiasis  the  intense  pain  can  be  modified  by  inhi- 
bition at  ninth  and  tenth  dorsal  spines,  right  side.  Inhibition 
at  this  point  also  lessens  the  contraction  of  the  abdominal 
muscles  and  thus  makes  direct  manipulative  treatment  possible. 
The  same  is  true  in  cases  of  appendicitis.  We  could  not  give 
direct  manipulative  treatment  in  such  cases  if  it  were  not  for 
the  power  of  inhibition  to  lessen  pain  in  the  affected  area  and 
the  consequent  muscular  contraction.  How  much  more  influ- 
ence is  exerted  over  the  nerves  of  the  appendix  and  surrounding 
region,  it  is  hard  to  say.  It  may  be  that  the  inhibition  arouses 
other  forces  of  a  stimulatory  character  to  be  brought  into 
action  to  empty  the  appendix.  Direct  manipulation  in  these 
cases  is  frequently  out  of  the  question. 

Inhibition  to  Remove  Lesions. — Inhibition  is  a  large 
and  necessary  part  of  many  treatments  given  for  the  purpose  of 
removing  a  definite  lesion,  for  if  inhibition  were  not  first  used, 
the  true  lesion  could  not  be  touched.  This  is  the  case  in  intes- 
tinal obstructions.  The  intestinal  irritation  causes  such  bowel 
contractions,  cramps,  and  contraction  of  the  abdominal  muscles 
that  the  physician's  fingers  cannot  palpate  the  disturbed  area. 
Inhibition  over  the  spinal  area  from  which  the  nerves  to  the  dis- 
turbed area  pass  out  will  cause  relaxation  of  the  muscles. 

In  a  case  of  pleurisy  which  came  under  the  author's  care 
an  opportunity  was  afforded  to  test  inhibition  unhampered 
by  any  other  method.  The  patient  could  not  bear  to  have  the 
right  arm  moved ;  respiration  was  exceedingly  shallow,  and 


PKINCIPLES  OF   OSTEOPATHY.  289 

the  physical  strength  was  very  low.  Hot  fomentations  had 
been  used,  but  to  lift  the  arm  caused  excruciating  pain  in  the 
side.  It  was  a  case  of  dry  pleurisy.  Steady  inhibition  was 
given  for  fifteen  minutes  between  the  transverse  processes 
on  the  right  side  in  the  area  between  the  third  and  the 
seventh  dorsal  vertebrae.  After  this  length  of  time  the  pa- 
tient could  raise  the  right  arm  above  the  head  and  take  much 
better  inspiration.  As  a  result  of  this  treatment  given  twice 
per  day,  the  patient  made  a  good  recovery,  though  all  the 
metabolic  processes  were  carried  on  in  a  very  unsatisfac- 
tory way. 

Passive  Movements  vs.  Rest. — According  to  Hilton's 
ideas,  as  expressed  in  "Rest  and  Pain,"  any  movement  of  the 
chest  muscles  would  be  contra-indicated  on  account  of  the  pain 
which  would  be  nature's  method  of  enforcing  rest  necessary 
for  the  cure.  The  patient  declared  that  the  deadening  of  the 
pain  and  the  consequent  possibility  of  movement  of  the  thorax 
seemed  to  revivify  the  entire  system,  as  well  it  might  on  ac- 
count of  the  increased  circulation  and  resultant  activity  of  all 
vital  processes.  Hilton's  theories  are  certainly  well  sustained 
by  his  argument,  but  when  we  consider  that  he  calls  adhesion 
of  tissues  a  cure,  we  are  compelled  to  strive  for  different 
results. 

In  chronic  diseases  one  has  ample  opportunity  to  search 
for  a  definite  lesion,  but  acute  diseases  usually  demand  rapid 
work,  and  one  must  be  ready  to  meet  the  demands  of  the  mo- 
ment. It  is  comparatively  easy  to  theorize  about  osseous 
lesions  here  and  there  in  acute  diseases,  but  only  those  who 
have  had  opportunity  know  what  it  is  to  attempt  to  set  sub- 
luxated  ribs  or  vertebrae  in  cases  of  pneumonia  or  appendi- 
citis. 

If,  as  Hilton  declares,  the  use  of  local  anaesthetics  over 
the  termination  of  sensory  nerves  which  are  reflexly  irritable  on 
account  of  inflammation  in  the  area  of  distribution  of  other 
nerves  from  the  same  segment  of  the  cord,  is  a  good  treatment, 
then  the  use  of  inhibition  as  applied  by  the  osteopath  is  surely 
more  rational  and  scientific. 

Inhibition  as  a  Preparatory  Treatment. — There  is  still 
another  time  when  inhibition  is  of  incalculable  value :  In 


290  PEINCIPLES   OF  OSTEOPATHY. 

making  examination  of  the  vagina  or  rectum,  especially  the 
former.  Several  times,  in  the  author's  practice,  examination 
of  the  vagina  seemed  impossible  without  great  distress  to  the 
patient.  The  irritability  of  the  mucous  membrane  of  the 
vagina  caused  intense  spasmodic  contraction  of  the  sphincter, 
but  steady  inhibition  over  the  third  and  fourth  sacral  for- 
amina for  about  five  minutes  caused  complete  relaxation,  and 
the  examination  could  then  be  made  without  any  trouble. 
Cases  have  been  reported  to  the  author  by  many  osteopaths 
describing  the  good  results  of  inhibition  in  gynecological  cases. 
These  cases  have  ranged  from  simple  nervous  vaginismus  to 
curettement.  Since  the  sacral  nerves  are  so  near  the  surface, 
and  are  not  interrupted  in  their  course  to  the  pelvic  viscera,  they 
afford  excellent  opportunity  for  the  good  effects  of  inhibition 
to  be  demonstrated. 

We  know  from  experience  that  osteopathy  can  do  wonder- 
ful work  in  removing  obstructions,  and  that  it  comes  nearer 
to  finding  all  these  obstructions  than  any  other  school  of  prac- 
tice ;  but  there  are  diseases  not  due  to  misplaced  tissue.  It 
behooves  us  to  study  how  we  can  get  results  in  those  cases  in 
which  no  physical  lesion  appears,  and  yet  function  is  greatly 
changed. 

CHAPTER  XVI. 

POSITIONS    FOR    EXAMINATION. 

In  order  to  be  systematic  in  the  examination  of  patients, 
it  is  well  to  adopt  the  use  of  a  certain  routine  of  positions 
which  will  best  show  the  details  of  osseous  structure. 

Testing  Alignment  and  Flexibility. — The  first  position, 
as  illustrated  in  Fig.  90,  flexes  the  spinal  column  and  makes 
the  spinotis  processes  prominent.  This  position  is  valuable  in 
examining  even  very  fleshy  people.  Approximation  or  sepa- 
ration of  the  spines  can  be  noted,  also  lateral  deviation.  If  the 
amount  of  flesh  over  the  spines,  as  in  fat  people,  precludes  the 
use  of  the  sense  of  sight,  you  can  ascertain  the  relation  by  the 
sense  of  touch. 

Sense  of  Touch. — I  wish  to  emphasize  the  necessity  of 


PEINCIPLES  OF  OSTEOPATHY. 


291 


the  students  acquiring  the  habit  of  depending  on  the  sense  of 
touch,  rather  than  of  sight.  In  all  osteopathic  examinations, 
the  sense  of  touch  should  be  used  to  obtain  those  data  concern- 
ing structure  which  form  the  basis  of  all  diagnosis.  Remember 
that  you  cannot  see  bone,  muscles  and  glands,  but  you  can 
feel  them. 


Fig.   90. — Flexion  of  the  spine    in    the    vertical    position    to    make    the 
spinous    processes    prominent. 


292 


PRINCIPLES  OF  OSTEOPATHY. 


Inspection. — While  the  patient  is  sitting  erect,  ascer- 
tain the  flexibility  of  the  spinal  column.  Note  the  position  of 
the  scapulae,  whether  near  or  far  from  the  spinal  column, 
whether  unevenly  placed.  Note  the  development  of  the  trapa- 
pezius,  latissimus  dorsi,  and  erector  spinae,  i.  e.,  observe  their 
surface  markings. 

Palpation  of  the  Ribs. — Fig.  91  illustrates  a  method  of 
bringing  the  ribs  prominently  into  view,  or  in  case  of  fleshy 


Fig.   91. — Position  to  accentuate   the   prominence  of  the  ribs. 


PRINCIPLES   OF  OSTEOPATHY.  293 

persons,  makes  it  easy  to  palpate  them.  By  pulling  the  arm 
up  and  across  the  chest,  the  latissimus  dorsi  is  stretched  which 
brings  the  four  lower  ribs  into  a  good  position  for  examination. 
The  movement  of  the  scapula  away  from  the  vertebrae  makes 
it  easier  for  the  examiner  to  feel  the  angles  of  the  fourth  and 
fifth  ribs.  It  is  not  well  to  depend  on  this  position  for  evi- 


Fig.  92. — Palpation  of  the  spine  in  the  vertical  position. 


294  PRINCIPLES   OF   OSTEOPATHY. 

dence  of  rib  subluxations,  because  the  tension  of  the  latissimus 
clorsi  brings  at  least  the  four  lower  ribs  into  proper  alignment. 
The  spacing  of  these  ribs  will  then  be  equal. 

The  chief  value  of  this  position  is  to  give  the  examiner 
better  opportunity  to  palpate  the  angles  of  the  ribs  above  the 
ninth  and  to  note  the  changed  relations  which  may  take  place  at 
the  anterior  end  of  the  ninth,  tenth,  eleventh  and  twelfth  ribs. 

Palpation  of  the  Spine. — After  gathering  as  much  in- 
formation as  possible  by  observing  the  form  of  the  back,  posi- 
tion of  the  scapulae  and  contour  of  the  muscles,  examine  the 
spine  by  means  of  your  sense  of  touch.  To  do  this,  have  the 
patient  sit  erect,  being  careful  not  to  exaggerate  the  normal 
posture,  i.  e.,  bend  the  spine  far  forward  or  backward  in  the 
lumbar  region.  A  marked  tendency  to  either  position  is  indica- 
tive of  weak  muscles.  Use  the  index  and  middle  finger  of 
either  hand  to  carefully  note  the  relations  of  the  individual 
vertebrae,  as  in  Fig.  92.  Begin  at  the  first  dorsal  and  work 
downward  to  the  sacrum.  Lateral  subluxations  are  easily 
noted  with  the  patient  in  this  position.  Gentle  digital  pres- 
sure may  be  made  at  the  prominent  side  of  any  subluxated 
vertebra  to  determine  the  degree  of  sensitiveness.  This  infor- 
mation is  best  secured  when  the  patient  is  reclining,  because  the 
muscles  are  relaxed.  While  the  patient  is  sitting  there  is 
usually  too  much  contraction  of  both  intrinsic  and  extrinsic 
muscles  of  the  back  to  allow  much  examination  outside  of  mere 
study  of  alignment  and  normal  or  abnormal  curves. 

Now  have  the  patient  recline  on  the  right  or  left  side, 
which  is  most  convenient,  as  in  Fig.  93.  Examine  the  condi- 
tion of  the  spinal  muscles  by  using  the  ball  of  the  fingers  of 
one,  or  both  hands.  Be  careful  not  to  use  the  ends  of  the 
fingers.  Commence  your  examination  at  the  first  dorsal  by 
noting  the  amount  of  sensitiveness  directly  on  or  between  the 
spinous  processes  all  the  way  to  the  coccyx.  To  elicit  this 
sensitiveness  use  a  moderate  pressure,  equal  to  about  six 
pounds.  With  this  much  pressure  the  patient  will  be  able 
to  distinguish  easily  between  the  sense  of  mere  pressure  and  a 
painful  or  hyper-sensitive  feeling. 

Begin  once  more  at  the  first  dorsal  and  examine  along  the 


PEIXCIPLES  OF  OSTEOPATHY. 


295 


sides  of  the  spines  and  about  three  inches  from  them.  This 
space  brings  the  internal  and  middle  groups  of  intrinsic  muscles 
under  your  fingers. 

Extrinsic  and  Intrinsic  Muscles  of  the  Back. — In 
speaking  of  extrinsic  and  intrinsic  muscles  of  the  back,  we 
desire  you  to  bear  in  mind  the  different  groups  as  they  are 
noted  in  Gray's  Anatomy.  Gray  divides  them  into  five  layers. 
The  first  three  layers  are  extrinsic,  i.  e.,  arise  from  vertebrae 
and  insert  into  the  humerus,  scapulae,  or  ribs.  They  depend 


Hi 


Fig.   93. — Palpation  of  the  dorsal  muscles — horizontal  position. 

upon  the  intrinsic  muscles  of  the  fourth  and  fifth  layers  to  fix 
the  spine  so  that  operating  from  the  spinal  column  as  a  fixed 
point,  they  can  move  the  upper  extremities  and  ribs. 

While  palpating  a  back  which  is  moderately  well  muscled, 
you  will  be  able  to  feel  through  the  upper  three  layers  and 
distinguish  the  condition  of  the  muscles  of  the  fourth  layer. 


296 


PRINCIPLES   OF  OSTEOPATHY. 


Fig.  94. — Diagram  of  dorsal  muscles — 1st,  2nd,  3rd  and  5th  layers. 


PRINCIPLES   OF  OSTEOPATHY. 


297 


Fig.    95.—- 


Diagram   of  dorsal   muscles — 4th  layer.      Adapted   from  a  dia- 
gram   in    Cunningham's    Anatomy. 


298  PRINCIPLES   OF  OSTEOPATHY. 

It  is  important  that  the  student  should  learn  to  feel  through 
the  soft  tissues  to  harder  ones  below.  Skill  in  detecting  vary- 
ing degrees  of  density  and  hardness  is  an  absolutely  essential 
qualification  of  the  diagnostician. 

A  careful  dissection  of  the  fourth  layer  will  disclose  the 
fact  that  there  are  three  parallel  groups  of  muscles.  The  first 
is  the  spinalis  dorsi  which  lies  on  the  side  of  the  spines.  The 
second  group  lies  more  on  the  transverse  processes.  The  lon- 
gissimus  dorsi  and  its  continuations  make  up  this  group.  The 
sacro-lumbalis  and  continuations  make  up  the  third  group 
which  lies  on  the  angles  of  the  ribs.  Careful  palpation  will 
distinguish  these  divisions. 

The  Diagnostic  Value  of  Hyperaesthesia. — Different 
points,  along  the  line  of  the  first  group,  which  are  hyper- 
sensitive may  be  evidence  of  direct  strain  of  a  single  vertebral 
articulation,  or  the  result  of  a  visceral  reflex,  or  even  in  sym- 
pathy with  a  rib  subluxation  which  affects  sensory  nerves 
reaching  the  same  segment  of  the  cord  from  which  its  nerves 
arise.  Hyperaesthesia  directly  upon  the  spines  is  found  usually 
in  connection  with  depression  or  elevation  of  the  spines,  not 
lateral  subluxation. 

Hyperaesthesia  at  points  in  the  second  group  of  muscles, 
i.  e.,  the  longissimus  dorsi  and  continuations  over  the  trans- 
verse processes,  may  result  from  vertebral  or  costal  subluxation, 
or  muscular  contraction  caused  by  visceral  reflex. 

When  this  excessive  sensitiveness  is  found  at  the  angles  of 
the  ribs  in  the  short  muscular  divisions  of  the  sacro-lumbalis 
and  continuations,  it  nearly  always  signifies  an  irritation  from 
a  costal  subluxation. 

The  examination  of  the  ribs  should  be  made  while  the 
patient  is  in  this  reclining  position.  The  fingers  should  follow 
the  angles  of  the  ribs,  noting  the  spacing,  special  prominence 
or  depression  of  an  angle,  then  noting  the  compensatory 
changes  at  the  chondro-costal  articulations.  In  this  way  the 
relation  of  the  ribs  to  each  other  can  be  determined. 

When  pain  exists  at  any  one  of  the  points  named,  or  the 
digital  pressure  arouses  a  painful  reflex,  all  of  the  sensory 
points  along  the  course  of  the  spinal  nerve  should  be  tested  in 


PE1NCIPLES   OF  OSTEOPATHY.  299 

order  to  determine  the  extent  of  the  nerve  irritation.  Take  for 
example,  the  point  on  the  spinal  column  between  the  fifth  and 
sixth  dorsal.  After  examining  these  two  spines  and  finding 
them  well  placed,  our  digital  pressure  at  the  sides  might  cause 
a  painful  reflex,  i.  e.,  the  patient  might  complain  of  our  pres- 
sure. Then  we  test  the  point  over  the  transverse  processes 
and  angles  of  the  ribs,  and  even  the  junction  of  the  ribs  and 
costal  cartilages.  If  hyperaesthesia  is  present  at  all  points  in 
the  distribution  of  the  fifth  spinal  nerve,  we  understand  that 
the  original  irritation  may  be  slight,  but  long  continued,  or 
strong  and  of  short  duration.  If  no  osseous  displacement  is 
discoverable  which  has  a  relationship  with  a  hypersensitive 
nerve,  we  must  look  for  evidence  of  disturbed  functioning  by 
the  viscus  most  nearly  related.  The  original  irritation  might 
have  been  an  excessive  demand  on  the  ability  of  the  viscus  as 
in  the  case  of  the  stomach  being  overloaded. 

In  any  case,  the  discovery  of  what  appears  to  be  an  osseous 
lesion,  leads  us  to  test  the  condition  of  its  related  nerves.  If 
they  do  not  show  undue  excitability,  the  lesion  is  doubtful 
as  a  causative  factor.  A  careful  examination  of  vertebral 
spinous  processes  may  show  many  deviations  from  symmetrical 
development,  and  the  diagnostician  should  guard  against  the 
false  evidence  of  these  distorted  spines.  If  a  spine  has  been 
distorted  by  unequal  development,  there  should  be  no  sensi- 
tiveness around  it  except  as  the  result  of  a  visceral  reflex.  In 
case  of  such  visceral  reflex,  the  examiner  cannot  help  being 
misled  as  to  the  value  of  the  apparent  osseous  malformation. 
His  fingers  cannot  inform  him  that  what  he  considers  an 
osseous  lesion  is  in  reality  bad  development.  The  only  way 
he  can  escape  from  making  a  mistake  is  by  continuing  his 
examination  without  holding  a  positive  idea  that  he  has  found 
the  cause.  The  history  and  development  of  the  case  may 
arouse  strong  doubts  as  to  the  value  of  his  discovered  spinal 
lesion. 

Your  attention  is  called  to  this  possible  mistake  in  valua- 
tion of  a  lesion  so  that  you  may  not  become  wedded  to  the 
idea  that  when  you  have  found  what  appears  to  be  a  mis- 


300 


PRINCIPLES   OF  OSTEOPATHY. 


placement,  you  are  free  to  end  your  examination  and  pro- 
nounce a  positive  opinion. 

Test  Muscular  Tension. — While  the  patient  is  on  his 
side,  examine  carefully  the  amount  of  tension  in  these  three 
groups  constituting  the  fourth  layer.  After  considerable  edu- 
cation of  the  sense  of  touch,  it  will  be  possible  for  you  to  deter- 
mine that  the  points  under  your  fingers  are  probably  too  sensi- 
tive. When  these  muscles  feel  hard  and  unyielding,  they  are 
usually  sore  to  pressure.  The  contractured  condition  of  the 
muscle  has  affected  the  sensory  nerve  filaments  in  two  ways: 


Fig    96. — Testing  the   pliability   of  the   interscapular   portion   of  the   spinal  column. 

First,  by  direct  pressure  between  the  contracted  muscle  bun- 
dles ;  second,  by  retention  of  metabolic  waste  products  which 
result  in  chemical  poisoning. 

Thoracic  Flexibility. — Fig.  96  illustrates  a  method  of 
ascertaining  the  elasticity  of  the  dorsal  spine  and  thorax. 
This  procedure  assists  in  estimating  the  general  condition  of 
the  body.  If  the  thorax  is  fixed,  inelastic,  respiration  cannot 


PEIXCIPLES   OF   OSTEOPATHY. 


301 


be  carried  on  properly.  Oxygenation  of  the  blood  will  be  im- 
perfect. 

Examination  of  the  Abdomen. — Fig.  97  shows  the 
proper  position  of  the  patient  for  examination  of  the  abdomen. 
The  knees  being  drawn  up  allows  relaxation  of  abdominal 
muscles.  Where  the  abdomen  is  very  sensitive  to  the  touch, 
either  because  of  pain  or  ticklishness,  use  the  whole  hand  until 
the  patient  becomes  somewhat  accustomed  to  the  touch.  Some- 
times it  is  necessary  for  the  physician  to  lift  the  feet  from  the 
table  and  flex  the  knees  quite  close  to  the  abdomen.  A  steady, 


Fig.    97. — Palpation   of   the   Abdomen. 

even  pressure  of  the  hand  on  the  abdomen  will  soon  become 
non-irritating  to  the  patient,  and  deeper  palpation  can  be  made. 
If  the  examination  is  a  general  one,  commence  your  work, 
with  the  patient  in  this  position,  by  palpating  the  thorax.  Note 
form  and  flexibility,  especially  the  flexibility  of  the  five  lower 
ribs.  The  free  movement  of  these  ribs  is  essential  to  manv 


302 


PKINCIPLES  OF  OSTEOPATHY. 


functions,  chiefly  respiration,  but  it  also  affords  a  sort  of 
rhythmical  massage  to  the  liver  and  stomach. 

Such  observations  of  form  and  flexibility  are  very  general, 
but  they  lead  invariably  to  some  clue  of  especial  value  in  the 
search  for  effects  and  their  causes. 

Elevation  or  Depression  of  Ribs. — Note  the  spacing  of 
the  ribs  to  determine  whether  any  rib  is  elevated  or  depressed. 
Palpate  the  chondro-costal  articulations  for  misplacements, 
especially  note  the  articulations  of  the  tenth  ribs,  they  are  fre- 


Fig.  98. — Position  for  examination  of  the  prostate  gland. 


PRINCIPLES  OF  OSTEOPATHY. 


3°3 


They 


quently  broken  loose  and  form  additional  floating  ribs, 
are  usually  depressed  slightly  under  the  ninth. 

After  palpation  of  the  chest,  use  percussion,  then  ausculta- 
tion, according  to  the  methods  outlined  in  the  best  text-books 
on  diagnosis.  By  the  use  of  all  these  physical  methods  it  is 
possible  to  arrive  at  a  very  definite  conclusion  of  the  state  of 
the  thoracic  viscera. 

The  abdomen  should  be  palpated,  then  percussed.  These 
two  methods  should  make  evident  any  organic  change  in  the 
abdominal  viscera. 


Fig.   99. — Simms'  position. 

Examination  of  the  Rectum  and  Prostate  Gland. — Fig. 
98  illustrates  a  position  for  examining  the  rectum  and  pros- 
tate gland.  Fig.  99  is  the  well-known  Simm's  position  which 
may  be  used  for  the  same  purpose  as  the  preceding. 

Other  positions  used  by  the  osteopath  for  examination  and 
treatment  are  the  well-known  gynecological  positions,  genu- 
pectoral  and  Trendelenburg. 

After  the  trunk  has  been  examined  in  these  various  posi- 
tions, the  neck  requires  attention. 

Examination  of  the  Neck. — For  easy  examination   of 


304  PEINCIPLES  OF  OSTEOPATHY. 

the  neck,  the  patient  should  be  recumbent,  as  in  Fig.  97.  The 
muscles  of  the  neck  must  have  all  tension  removed  so  that  the 
examiner's  fingers  can  feel  the  processes  of  the  cervical  verte- 
brae. 

A  flat  table  instead  of  the  model  shown  in  the  illustration 
is  better.  A  hard  small  pillow  may  be  used  to  support  the  head. 

Since  the  spinous  processes  in  the  cervical  region  are  short 
and  bifid,  and  oftentimes  developed  unevenly  and  are  covered 
with  several  layers  of  muscles  and  ligaments,  it  is  not  satis- 
factory to  use  them  as  land  marks  for  relations  of  cervical 
vertebrae. 

The  tubercles  on  the  transverse  processes  are  easily  pal- 
pated, hence  these  serve  as  guides  in  the  detection  of  slight 
misplacments  of  cervical  vertebrae. 

The  transverse  processes  of  the  atlas  are  usually  large  and 
sufficiently  prominent  to  enable  the  examiner  to  ascertain  accu- 
rately its  position.  When  the  atlas  is  in  its  true  position,  its 
transverse  processes  will  be  found  about  midway  between  the 
mastoid  processes  of  the  temporal  bones  and  the  angles  of  the 
jaw.  This  relationship  may  appear  untrue  when  the  mastoid 
processes  are  quite  large  or  small,  or  the  angles  of  the  jaw  are 
more  or  less  obtuse.  It  is  necessary  to  study  the  relative  de- 
velopment and  positions  in  every  case,  on  both  sides,  in  order 
to  discover  whether  a  subluxation  exists.  The  fact  that  nearly 
all  subluxations  of  the  atlas  are  twists  instead  of  direct  forward 
or  backward  displacements,  makes  it  comparatively  easy  to 
detect  the  inequalities  and  understand  the  faulty  position. 
Sensitiveness  will  be  found  in  the  tissues  on  the  side  whose 
transverse  process  is  posterior.  In  case  there  is  marked  sensi- 
tiveness on  both  sides,  that  is,  on  the  posterior  surfaces  of 
both  transverse  processes,  the  atlas  is  probably  drawn  slightly 
p-osterior  on  both  sides  by  the  severe  contraction  of  its  attached 
muscles. 

The  third  cervical  vertebra  seems  to  be  easily  subluxated. 
It  is  usually  twisted,  not  sufficiently  to  lock  its  articular  pro- 
cesses, but  just  enough  to  make  the  dorsal  surface  of  its  infe- 
rior articular  process  easily  palpable  through  the  muscles  which 


PEINCIPLES  OF   OSTEOPATHY.  305 

lie  over  it.     This  prominent  point  will  be  sensitive  because  the 
muscles  over  it  are  always  tense. 

Sometimes  the  sixth  cervical  vertebra  is  twisted.  When 
this  condition  exists,  there  is  marked  disturbance  of  circulation 
in  the  head.  The  patient  is  usually  wakeful  and  excitable  on  ac- 
count of  the  congested  condition  of  the  cerebral  blood  vessels, 
caused  by  the  pressure  on  the  vertebral  veins. 

Note  the  tone  of  all  the  cervical  muscles,  the  flexibility  of 
the  neck,  the  temperature  of  the  skin  on  different  parts  of  the 
neck.  Palpate  the  chains  of  lymphatic  glands,  the  thyroid  and 
the  submaxillary  salivary  glands. 

After  a  thorough  palpation  of  the  neck,  look  carefully  for 
any  evidences  of  disturbed  circulation  in  the  head  as  may  be 
evidenced  by  the  appearance  of  the  skin,  mucous  membrane  of 
the  mouth,  the  tonsils,  conjunctiva  or  the  wearing  of  glasses. 
Your  knowledge  of  optics  should  enable  you  to  judge  the 
condition  of  the  eyes  by  inspection  of  the  glasses  worn. 

Such  an  examination  of  the  head  and  neck  as  herein  out- 
lined should  give  the  examiner  a  good  understanding  of  the 
structural  and  functional  condition  existing  at  the  time  of 
examination,  and  even  guide  him  to  what  other  parts  of  the 
body  may  need  special  attention. 

The  History  of  Lesions. — All  structural  and  functional 
facts  determined  by  your  examination  are  historical,  that  is, 
they  have  dates  and  circumstances  which  give  them  much  or 
little  value.  The  experienced  diagnostician  delights  in  filling 
in  the  life  history  of  the  patient  to  fit  the  structural  and  func- 
tional changes.  Herein  lies  the  opportunity  for  the  physician 
to  bring  to  his  aid  all  his  resource  of  experience  and  educa- 
tion in  judging  how  these  lesions  have  been  brought  about 
and  how  they  are  now  influencing  other  tissues. 

The  Extremities. — While  the  patient  is  in  the  recum- 
bent dorsal  position,  Fig.  97,  the  lower  extremities  can  be 
examined.  Note  the  comparative  length  of  the  legs,  but  be 
careful  to  eliminate  all  possibility  of  mistake  by  observing 
whether  the  patient  is  lying  evenly  on  the  back,  ilia  same 
height,  and  muscles  of  both  legs  equally  relaxed.  A  measure- 


306  PRINCIPLES  OF  OSTEOPATHY. 

ment  from  the  anterior  superior  iliac  spine  to  the  internal  mal- 
leolus  determines  the  length  of  the  leg. 

Palpate  the  great  trochanter.  Note  its  relation  to  Nela- 
ton's  line.  These  general  directions  for  examination  will  de- 
termine the  weak,  disordered  or  diseased  part  of  the  body 
which  requires  your  further  careful  examination. 

Subjective  Symptoms. — You  willi  observe  that  thus  far 
nothing  whatever  has  been  said  about  asking  the  patient  con- 
cerning his  or  her  subjective  symptoms.  It  is  a  general  prin- 
ciple underlying  osteopathic  diagnosis  that  objective  symptoms 
are  the  only  true  facts  upon  which  the  diagnostician  dares  base 
his  judgment  and  final  verdict.  The  nearest  approach  to  a 
subjective  symptom  thus  far  mentioned  is  hyperaesthesia.  This 
may  frequently  be  judged  by  the  feeling  of  the  muscle  when 
pressed  upon  by  the  fingers.  The  muscular  reaction  to  the 
painful  sensory  impressions  occasioned  by  the  pressure  can  be 
felt.  Usually  we  depend  upon  the  patient  to  indicate  or  cor- 
roborate our  sense  of  touch. 

In  actual  practice  this  process  is  not  carried  out  in  its 
entirety.  Time  is  a  factor  in  the  physician's  life  as  well  as  in 
the  life  of  the  business  man.  He  cannot  afford  to  go  about  his 
work  in  this  detective-like  manner.  It  requires  too  much  time. 
We  hear  a  great  deal  of  objection  to  the  physician's  question  to 
his  patient:  "What  is  your  trouble?"  But  the  answer  to  it 
enables  him  to  get  quickly  to  work  on  the  seat  of  disease  or  at 
least  leads  him  quickly  to  it.  The  physician  who  is  a  good 
questioner  saves  much  time.  He  does  not  accept  the  subject- 
ive symptoms,  merely  goes  to  work  to  prove  or  disprove  their 
verity  by  the  standards  of  physical  diagnosis. 


CHAPTER  XVII. 


MANIPULATION. 

After  an  examination  has  resulted  in  the  location  of  a 
lesion,  it  is  necessary  to  consider  the  therapeutic  methods  for 
correcting  it.  The  lesions  which  are  discovered  may  be  osse- 
ous, muscular  or  ligamentous,  resulting  in  the  perversion  of 


PRINCIPLES  OF  OSTEOPATHY.  307 

some  physiological  process,  such  as  an  increase  or  decrease 
of  blood  supply  or  secretion,  etc.  The  symptoms  of  the  case 
are  only  surface  evidence  of  disturbances  of  structure.  The 
examiner  must  not  be  misled  by  symptoms ;  more  than  this, 
he  must  not  let  symptoms  claim  his  whole  attention  when  ad- 
ministering his  therapeutics. 

Methods  of  Procedure. — Osteopathic  physicians  fre- 
quently differ  as  to  methods  of  procedure,  but  they  all  work 
according  to  the  same  principle.  For  instance,  a  subluxation 
of  a  vertebra  might  be  discovered  by  two  osteopaths.  The 
first  one  might  undertake  to  reduce  the  subluxation  without 
any  preliminary  work  on  the  muscles,  believing  that  it  is  best 
to  go  right  to  the  seat  of  trouble  and  remove  it.  His  treat- 
ment would  be  severe  because  much  strength  would  be  re- 
quired to  overcome  the  resistance  of  the  muscles  governing 
the  articulation.  The  second  one  might  spend  considerable 
time  on  the  preliminary  work  of  relaxing  the  muscles  of  the 
articulation,  increasing  flexibility,  reducing  sensitiveness,  etc., 
before  attempting  any  specific  reduction  of  the  lesion.  The 
ultimate  result  of  both  methods  would  be  alike.  The  question 
of  which  method  is  best  lies  wholly  with  the  individual  osteo- 
path. Some  like  to  put  forth  a  severe  effort  for  a  short  time, 
others  a  moderate  effort  for  a  longer  time.  Outside  of  the 
special  choice  of  the  osteopath,  lies  the  business  one  of  satisfy- 
ing the  patient.  Severe  work  at  the  outset  frightens  some 
patients,  furthermore,  it  actually  bruises  some  of  them.  The 
ultimate  result  of  the  treatment  may  be  excellent,  but  the  pa- 
tient does  not  quickly  forget  the  methods  used.  There  is  a 
parallel  between  the  immediate  after-results  of  a  severe  osteo- 
pathic  treatment  and  surgical  shock.  This  shock  should  be 
avoided  as  much  as  possible. 

The  movements  hereafter  pictured  and  described  are  all 
made  with  reference  to  structure  rather  than  function.  Few 
references  are  made  concerning  their  applicability  to  special 
diseases.  We  do  not  care  what  the  name  of  the  disease  is. 
The  groups  of  symptoms  which  make  up  the  pictures  described 
in  symptomatology  have  very  little  significance  to  the  osteo- 
path. His  movements  are  not  made  with  reference  to  a  named 


3o8 


PKINCIPLES  OF  OSTEOPATHY. 


disease,  but  to  a  faulty  structural  condition.  The  structural 
condition  may  be  the  basis  for  the  physiological.  Function 
does  affect  structure.  We  are  not  to  lose  sight  of  this  fact. 
Function  may  be  perverted  by  bad  habits,  hence  our  therapeu- 
tics must  comprehend  the  hygienic  and  dietetic  side  of  life  as 
well  as  structural. 

Each  movement  herein  outlined  secures  a  definite  effect 
on  a  muscle,  or  is  used  to  affect  the  relation  of  bony  parts. 


Fig     100.- — Relaxation    of    the   latissimus   dorsi. 

The  movements  made  to  affect  the  muscles  of  the  back 
and  spinal  column  are  based  upon  the  attachment  of  the  mus- 
cles and  the  leverage  they  exert  on  the  spinal  column. 

Relaxation  of  the  Latissimus  Dorsi. — The  arrangement 
of  the  back  muscles  has  been  noted  in  the  chapter  on  Positions 
for  Examination.  In  order  to  relax  these  muscles  in  their 


PRINCIPLES  OF   OSTEOPATHY.  309 

natural  relations,  i.  e.,  from  superficial  to  deep  groups,  we 
begin  with  such  a  movement  as  will  separate  the  extremities 
of  the  most  superficial  muscles  to  their  fullest  extent.  Fig.  100 
illustrates  the  method  of  relaxing  the  latissimus  dorsi.  One 
hand  extends  the  arm  to  its  fullest  extent,  the  other  hand  an- 
chors the  ilium.  It  will  be  noted  that  the  lower  dorsal  and 
lumbar  portions  of  the  spinal  column  are  lifted  by  the  pull 
of  this  muscle.  Also  the  four  lower  ribs  are  raised.  The 
intrinsic  effect  of  this  stretching  movement  is  to  take  most 
of  the  tension  out  of  the  muscle  itself  and  increase  the  amount 
of  metabolic  change  taking  place  within  it.  But  that  is  not 
what  is  primarily  intended.  The  intrinsic  effects  are  mere 
incidents  in  the  physiological  life  of  the  muscle,  and  as  such 
are  found  following  all  kinds  of  muscular  movements.  The 
extrinsic  effects  are  what  concern  us  most;  the  effect  upon 
the  vertebrae  and  ribs,  the  change  in  the  form  of  the  chest. 

There  are  three  uses  for  this  movement.  First,  as  pre- 
paratory to  work  upon  muscles  lying  beneath  it,  i.  e.,  purely 
relaxing.  Second,  in  case  of  overlapping  by  any  one  of  the 
four  lower  ribs.  It  is  a  common  condition  to  find  the  twelfth 
rib  under  the  eleventh,  or  tenth  under  eleventh.  The  pull  of 
the  latissimus  dorsi  is  exerted  on  all  alike,  hence  the  individual 
ribs  are  brought  into  their  proper  relations.  Relaxation  usually 
allows  a  return  of  the  faulty  position,  but  if  the  ribs  are  held 
at  their  extremities  by  the  operator  for  a  few  seconds  after 
relaxation,  the  intercostal  muscles  and  quadratus  lumborum 
will  be  filled  with  arterial  blood  which  tones  them.  The  patient 
should  be  directed  to  hang  by  the  hands  several  times  per  day 
so  as  to  get  the  good  effect  on  the  position  of  the  lower  ribs. 
Third,  to  affect  lateral  curvature  of  the  spine  in  the  lumbar  or 
lower  dorsal  portion. 

Relaxation  of  the  Trapezius. — The  trapezius  is  another 
of  the  superficial  group  of  back  muscles.  Its  fibres  are  so  vari- 
ously attached  that  several  movements  are  required  to  relax 
all  its  divisions.  Fig.  101  illustrates  the  method  of  grasping 
and  holding  the  scapula  while  relaxing  the  trapezius.  The 
scapula  is  rotated  on  the  thorax  as  far  as  possible  toward  the 
head  so  as  to  stretch  those  fibres  extending  from  the  spine 


310  PKINCIPLES  OF  OSTEOPATHY. 

of  the  scapula  to  the  sixth  and  twelfth  dorsal  spines ;  then 
away  from  the  head  to  affect  the  cervical  fibres,  then  away  from 
the  spinal  column  to  relax  the  short  fibres  between  the  upper 
dorsal  spines  and  scapula.  There  is  a  vast  difference  in  the 
way  the  scapula  can  be  moved  about  in  different  cases.  Those 
having  any  tendency  to  asthmatic  trouble  will  present  a  very 
fixed  scapula.  The  more  marked  the  asthmatic  condition  is, 
the  more  difficult  it  is  to  move  the  scapula.  Pleurisy  and  lung 


Fig.    101. — Relaxation   cf  the  trapezius. 

troubles,  especially  when  coughing. is  frequent,  tend  to  hold 
the  scapula  fixed.  Lifting  the  patient's  body  above  the  table 
by  the  scapula  gives  instant  relief  in  many  cases  of  pleuritic 
pain,  intercostal  neuralgia  or  angina  pectoris.  This  result  is 
explained  by  the  removal  of  the  pressure  exerted  by  the  scapula 
when  it  is  held  too  close  to  the  thorax  by  contracted  muscles 


PRINCIPLES  OF  OSTEOPATHY.    •  311 

which  are  acting  reflexly.  A  subluxated  rib  is  usually  respon- 
sible for  the  pains  mentioned,  but  the  muscles  of  the  scapula 
are  partially  respiratory,  hence  act  in  connection  with  disturb- 
ances of  normal  rhythm  of  intercostal  muscles.  The  pres- 
sure of  the  scapula  helps  to  fix  the  whole  chest  in  an  unyield- 
ing condition.  That  which  was  at  first  purely  helpful  in  char- 
acter becomes  in  itself  an  added  irritant. 


Fig.    102. — Relaxation    of    the    rhomboideus    major    and    minor. 

This  movement  or  series  of  movements  affects  the  tone  of 
the  muscle  fibres,  then  the  whole  respiratory  process. 

Relaxation  of  the  Rhomboids. — In  the  second  group  of 
back  muscles  we  find  the  rhomboids,  major  and  minor,  acces- 
sory muscles  of  inspiration.  Fig.  102  illustrates  a  method  of 


312 


PEINCIPLES  OF  OSTEOPATHY. 


stretching  these  muscles.  The  patient's  elbow  is  placed  against 
the  physician's  abdomen.  Pressure  against  the  elbow  forces 
the  scapula  back,  and  makes  its  vertebral  border  prominent. 
The  physician's  fingers  grasp  this  border  securely,  and  then 
lift  steadily  upward.  This  movement  is  excellent  for  the  pur- 
pose intended.  That  which  has  been  written  concerning  the 
trapezius  is  applicable  to  the  rhomboids.  Outside  of  the  in- 


F:g.   103. — Relaxation  of  the  pectoralis  major  and  serratus  magnus. 

trinsic  effects  on  the  muscle  and  on  respiration,  a  slight  effect 
may  be  exerted  on  a  lateral  curve  in  the  interscapular  region. 
It  is  generally  used  as  preparatory  to  work  on  deeper  struc- 
tures. 

The  Pectoralis  Major  and  Serratus  Magnus. — Following 
these  movements,  where  general  thoracic  and  spinal  relaxation 


PEINCIPLES   OF  OSTEOPATHY. 


313 


are  desired,  the  movement  illustrated  in  Fig.  103  may  be  used. 
It  affects  the  Pectoralis  Major  and  Serratus  Magnus.  By 
pushing  the  patient's  elbow  as  far  back  as  possible,  the  scapula 
is  approximated  to  the  spinal  column,  hence  the  serratus  mag- 
nus  is  put  upon  a  tension  which  lifts  the  eight  upper  ribs.  The 
pectoralis  major  also  affects  the  upper  ribs.  The  phy- 
sician's hand  on  the  angles  of  the  ribs  accentuates  the  ex- 
pansion of  the  chest.  This  is  a  general  movement,  but  one 


Fig     104. — Relaxation   of  the  serratus  magnus  and  some   fibers  of  the   fourth   layer 
of   dorsal    muscles. 

which  has  far-reaching  effects  upon  respiration  and  circula- 
tion. It  is  adaptable  to  many  specific  structural  defects  of  the 
ribs. 

In  Fig.  104  the  physician  again  uses  the  humerus  and 
scapula  as  means  by  which  to  affect  the  spinal  column.  The 
left  hand  exerts  traction  on  the  muscles  above  the  spine,  while 
the  right  hand  and  arm  forces  the  patient's  scapula  toward  the 
head  and  spine.  The  movement  is  made  to  enable  the  physi- 
cian to  relax  the  serratus  magnus  and  some  of  the  fibres  of  the 


3'4 


PRINCIPLES  OF  OSTEOPATHY. 


fourth  layer  of  the  back.     Slight  torsion  of  the  dorsal  spinal 
column  is  also  secured. 

Quadratus  Lumborum. — The  relaxation  of  the  quad- 
ratus  lumborum  is  secured  according  to  Fig.  105.  In  all  dis- 
placements of  the  twelfth  rib,  it  is  necessary  to  secure  a  free 


Fig.    105. — Relaxation   of   the   quadratus    lumborum. 

circulation  'in  the  muscles  attached  to  that  rib.  The  fact  that 
it  is  a  floating  rib  makes  its  position  dependent  on  the  tone  of 
the  muscles  attached  to  it.  It  is  frequently  slipped  under  the 
eleventh.  This  movement  separates  them. 

Fig.  106  is  in  some  respects  similar  to  the  movement  illus- 
trated in  Fig.  104,  except  that  the  scapula  is  forced  downward, 
and  the  left  hand  is  able  to  work  through  the  relaxed  super- 


PEINCIPLES  OF  OSTEOPATHY. 


315 


ficial  muscles.  After  the  use  of  the  movements  already  illus- 
trated, it  is  astonishing  how  easily  one  can  work  upon  the 
fourth  layer  or  examine  the  condition  of  deep  structures. 

Erector  Spinae. — The  work  upon  the  fourth  layer 
should  be  done  according  to  Fig.  93.  The  fingers  are  placed 
between  the  muscles  and  the  spines  of  the  vertebrae  and  then 
drawn  away  from  the  spines  in  such  a  manner  as  to  stretch  the 
muscles.  The  fingers  should  never  be  allowed  to  slip  over  the 
muscles.  Work  steadily  and  deeply.  Do  not  move  the  fingers 
over  the  skin.  When  you  place  your  fingers,  compel  all  soft 


Fig.   1 06. — Relaxation  of  the  lower  fibers  of  the  trapezius. 

tissues  beneath  them  to  move  with  them.  In  this  way  you 
secure  relaxation  of  the  erector  spinae  and  continuations,  take 
out  soreness  of  the  muscles,  and  prepare  for  specific  work  upon 
the  ribs  or  vertebrae. 

The  erector  spinae  is  rarely  contracted  throughout  its 
whole  length.  Your  work  should  be  centered  on  that  portion 
which  your  examination  has  demonstrated  to  be  contracted, 
either  as  a  result  of  visceral  disturbance,  osseous  subluxation, 
strain  or  cutaneous  reflex  from  cold. 


PRINCIPLES  OF  OSTEOPATHY. 


Having  now  prepared  our  patient  for  specific  manipulation, 
we  will  note  the  results  to  be  obtained  on  the  general  contour 
of  the  spinal  column. 

Treatment  of  Simple  Kyphosis. — Fig.  107  illustrates 
one  of  the  simplest  methods  of  springing  a  spine  which  is 
kyphosed  at  the  junction  of  the  dorsal  and  lumbar.  The  phy- 
sician's forearms  are  placed  against  the  patient's  shoulder  and 


Fig.  107. — A  method  of  springing  a  dorso-lumbar  kyphosis. 

ilium  while  the  fingers  rest  over  the  kyphosed  portion  of  the 
spinal  column.  The  hands  draw  forward  while  the  forearms 
push  away.  Considerable  force  can  be  exerted  in  this  way 
on  slender  patients. 

Great  force  can  be  exerted  on  a  posterior  curve  of  the 
lower  dorsal  and  lumbar  portions  by  the  movement  shown  in 
Fig.  108.  This  movement  is  also  used  for  purposes  other  than 


PEINCIPLES  OF  OSTEOPATHY. 


317 


corrective  of  structural  defects.  Since  the  leverage  is  so  great, 
it  is  quite  easy  for  the  physician  to  carry  it  too  far.  The  re- 
sult is  an  active  congestion  of  the  lower  portion  of  the  spinal 
cord  followed  by  excessive  activity  of  the  nerve  centers  located 
there.  In  giving  this  movement  to  women,  ascertain  whether 
pregnancy  exists.  If  so,  do  not  under  any  consideration  use 
it.  The  center  for  parturition  might  be  excited  by  it,  even 
though  the  movement  made  is  slight. 

There  is  practically  no  danger  in  this  movement  when  in- 
telligently used,  except  in  the  case  of  pregnancy.     A  slow, 


Fig.  1 08. — A  method  of  springing  a  lumbar  kyphosis. 

steady  lift  made  while  the  physician  is  watching  carefully  the 
amount  of  resistance  offered  by  the  back  will  usually  inhibit  the 
excitement  of  the  centers  located  in  the  lumbar  enlargement  of 
the  spinal  cord.  The  slowness  and  steadiness  of  the  move- 
ment relaxes  the  muscles  of  the  fifth  layer  and  secures  better 
drainage  for  the  blood  in  the  spinal  canal.  No  active  congestion 
is  brought  on,  hence  a  sedative  effect  is  gained.  Quick,  in- 
tense execution  of  this  movement  has  frequently  a  reverse 
effect,  because  the  sharp  strain  put  upon  the  muscles  results  in 
added  contraction,  active  congestion  and  obstruction  to  good 
drainage  of  the  spinal  canal.  These  conditions  result  in  func- 
tional activity  of  those  organs  governed  by  the  nerve-cells  in  the 


3i8  PRINCIPLES  OF  OSTEOPATHY. 

lumbar  enlargement.  Active  congestion  of  a  center  results  in 
increased  function  of  the  organ  governed  by  that  center. 

As  a  general  rule,  this  movement  is  contra-indicated  for 
any  purpose  but  that  of  correcting  a  structural  defect.  The  re- 
action of  many  patients  is  an  uncertain  quantity,  hence  it  is  not 
wise  to  use  this  treatment  for  purely  functional  effects. 

As  a  result  of  the  ignorant  use  of  this  movement  by  those 
who  are  palming  themselves  off  as  osteopaths,  the  author  knows 
of  several  cases  where  dangerous  conditions  were  brought  on. 


Fig.  109. — A  method  of  springing  an  upper  dorsal  lordosis. 

Lordosis — Upper  Dorsal. — An  anterior  curve  or 
straightened  condition  of  the  spine  in  the  interscapular  region  is 
rather  difficult  to  treat  on  account  of  inability  of  the  physician 
to  use  the  extremities  as  levers.  Fig.  109  illustrates  a  method 
of  applying  leverage  by  means  of  the  cervical  vertebrae.  The 


PRINCIPLES   OF   OSTEOPATHY.  319 

position  of  the  knee  on  the  spinal  column  regulates  the  extent 
of  the  force  of  the  movement.  The  knee  is  the  weight  to  be 
lifted,  the  spinal  column  is  a  flexible  lever.  The  physician's 
forearms  are  the  fulcrum,  while  his  hands  apply  the  force  to  lift 
the  \veight  (the  knee)  which  bends  the  lever  at  the  point  gov- 
erned by  the  position  of  the  weight  and  fulcrum.  The  position 
of  the  physician's  hands  is  important,  because  the  cervical  is  not 
the  portion  of  the  spinal  column  we  desire  to  bend.  If  the 
hands  are  allowed  to  rest  close  to  the  head,  the  force  exerted  is 
nearly  all  spent  on  the  neck ;  the  most  flexible  part  of  the  spinal 
column  is  affected — a  result  not  desired.  Place  the  hands  as 
nearly  over  the  cervical  and  1st  dorsal  spines  as  possible.  Since 
the  junction  of  the  dorsal  and  lumbar  segments  is  a  very  flex- 
ible point,  the  knee  should  be  located  higher. 

The  Possible  Variety  of  Movements  Which  Will  Se- 
cure the  Same  Results. — All  of  the  effects  described  may 
be  secured  by  movements  differing  from  those  outlined.  The 
author  desires  to  illustrate  the  application  of  osteopathic  prin- 
ciples. It  is  believed  by  him  that  the  series  of  movements  illus- 
trated have  the  virtue  of  directly  and  forcibly  affecting  the  part 
desired  without  using  up  too  much  of  the  physician's  strength 
in  their  application.  Where  much  work  is  done  by  a  physician, 
it  becomes  a  vital  problem  with  him  how  to  conserve  his  own 
strength.  By  the  selection  of  those  movements  which  give  th«» 
greatest  leverage,  he  saves  himself. 

The  Head  and  Neck  as  a  Lever. — If  the  anterior  or 
straightened  condition  of  the  spine  is  very  marked  in  the  upper 
dorsal,  it  is  possible  for  the  physician  to  use  the  head  and  neck 
in  securing  his  leverage.  When  the  position  of  the  spine  is  as 
described,  the  spinal  muscles  in  that  area  will  be  very  con- 
tracted. The  vertebrae  will  be  held  tightly  together,  thus  lessen- 
ing the  flexibility.  Loss  of  flexibility  of  the  spinal  column  re- 
sults in  poor  circulation  in  the  spinal  cord  with  consequent  per- 
version of  the  activity  of  the  physiological  nerve  centers  located 
there.  Congestion,  passive  type,  usually  exists  around  these 
centers  when  drainage  is  interfered  with  by  these  contracted 
muscles.  The  nerve  centers  manifest  their  irritation  by  such 
conditions  as  bronchitis,  pleurisy,  etc.,  that  is,  a  congestion 


320  PRINCIPLES  OF  OSTEOPATHY. 

exists  at  the  peripheral  distribution  of  the  nerve  similar  to  that 
at  its  origin. 

Lordosis  or  Kyphosis  May  Affect  a  Function  Similarly. 
— A  change  in  the  contour  of  the  spine,  either  anterior  or  pos- 
terior, may  result  in  the  same  disturbances  in  the  peripheral  dis- 
tribution of  the  nerves  from  the  distorted  section.  The  anterior 
curve  in  the  interscapular  region  usually  causes  the  ribs  to 
droop,  which  occasions  a  flat  chest.  The  thoracic  cavity  is 
lessened,  hence  respiration  is  feeble.  People  with  flat  chests 
may  develop  wonderful  breathing  capacity  by  persistent  exer- 
cise. The  respiratory  muscles  lift  the  ribs.  Exercise  of  these 
muscles  will  increase  the  antero-posterior  diameter  of  the  chest. 

When  directing  a  patient  about  the  details  of  exercise  to  in- 
crease the  breathing  capacity,  do  not  fail  to  impress  the  fact  that 
a  full  round  chest  without  flexibility  is  just  as  bad  a  condition 


.    no. — Voluntary  treatment  of  an  upper  dorsal  lordosis. 


as  an  abnormally  flat  chest.  Flexibility  is  the  keynote  of  health. 
Those  exercises  which  merely  increase  the  contracting  power 
of  muscle,  without  at  the  same  time  increasing  their  relaxing 
power  are  not  healthful. 

Examination  shows  that  whether  we  have  anterior  or  pos- 
terior conditions  in  the  interscapular  region,  the  spinal  muscles 
are  contracted.  The  patient's  power  to  relax  them  is  lost. 


PRINCIPLES  OF  OSTEOPATHY. 


321 


The  patient  may  feel  tired  and  weak,  but  these  muscles  will 
not  cease  their  contraction.  The  rigidity  has  passed  beyond 
the  patient's  control. 

The  patient  can  do  something  toward  restoring  flexibility 
to  an  anteriorly  curved  or  straight  spinal  column  in  the  upper 
dorsal  region.  Fig.  no  illustrates  the  effect  of  flexing  the 
neck  forcibly  by  pulling  down  with  the  hands.  These  spines 
are  greatly  separated,  and  hence  the  muscles  of  the  fourth  and 
fifth  lavcrs  are  relaxed. 


Fig.   in. — Use  of  the  head  and  neck  as  a  flexible  lever  to  affect  the 
upper   dorsal   region. 

Fig.  in  illustrates  how  the  physician  can  use  the  dorsal 
and  cervical  vertebrae  as  a  flexible  lever,  and  by  shifting  the  po- 
sition of  the  hand  upon  the  spine  apply  the  movement  specific- 
ally to  any  particular  vertebra.  No  movement  which  uses  the 
arms  as  levers  will  affect  the  position  of.  these  vertebrae,  be- 


322 


PRINCIPLES  OF  OSTEOPATHY. 


cause  the  first  and  second  layers  of  muscles  which  are  affected 
by  arm  movements  do  not  control  the  intrinsic  mobility  of  this 
portion  of  the  spinal  column.  The  fourth  and  fifth  layers  of 
back  muscles  are  the  groups  which  cause  the  mal-position  of 
vertebrae  in  this  region. 

Splenius  Capitis  et  Colli. — The  Splenius  Capitis  et 
Colli,  a  muscle  of  the  third  group,  extends  as  low  as  the  sixth 
dorsal  spine.  As  its  name  indicates,  it  is  a  bandage  muscle, 
and  binds  down  the  muscles  under  it.  Its  long  attachment  in 
the  dorsal  region  gives  it  a  considerable  influence  there,  when 
its  superior  attachments  to  the  head  and  neck  are  forced  an- 


Fig.    112. — A    method    of    affecting    kyphosis    in    the    upper    dorsal    region. 

teriorly  by  flexion  of  the  neck.  It  is  the  influence  of  this  mus- 
cle which  makes  the  movements  described  so  effective.  These 
movements  are  for  a  general  corrective  effect  on  a  section  of 
the  spinal  column.  They  are  not  well  adapted  to  treatment  of 
an  individual  vertebra. 

Kyphosis — Upper  Dorsal. — A  posterior  curve    in    the 
upper  dorsal  region  can  be  treated  by  the  method  illustrated  in 


PRINCIPLES  OF  OSTEOPATHY. 


323 


Fig.    113. — A   method   of    affecting   kyphosis    in    the    dorso-lumbar    region. 

Fig.  112.  The  physician's  right  arm  is  placed  above  the  pa- 
tient's right  shoulder  and  under  the  chest,  so  that  the  hand  can 
be  placed  in  the  patient's  left  axilla.  The  patient's  head  should 


324 


PEINCIPLES  OF  OSTEOPATHY. 


Fig.    114. — A   method   of   affecting   kyphosis   in   the   lower   dorsal   region. 

be  turned  away  from  the  physician,  so  that  the  upward  pressure 
of  his  arm  will  not  interfere  with  the  trachea.  The  physician's 
left  hand  may  be  moved  from  place  to  place  along  the  spinal  col- 
umn. The  farther  the  hands  are  separated,  the  more  leverage 


PRINCIPLES   OF  OSTEOPATHY. 


325 


is  gained.  Considerable  force  can  be  exerted  in  this  movement 
without  any  danger  to  the  patient,  in  fact  to  be  of  any  value  it 
must  be  made  forcefully.  The  primary  use  of  this  procedure 
is  to  reduce  the  excess  of  posterior  curve. 

That  which  has  been  written  concerning  the  nerve  centers 
in  the  interscapular  region  when  straightening  or  anterior 
curvature  of  the  spine  exists,  applies  equally  to  the  posterior 
curvature. 


^i^.    US-- — A  method  of  affecting  kyphosis  in  the  lumbar  region. 

Posterior  curvature  is  accompanied  by  increased  antero- 
posterior  diameter  of  the  chest,  and  loss  of  flexibility.  This 
movement  increases  flexibility.  It  can  easily  be  adapted  to  the 
treatment  of  the  fifth  or  sixth  ribs. 

Kyphosis — Dorso-lumbar. — When  the  kyphosis  is  at 
the  junction  of  the  dorsal  and  lumbar  regions,  it  is  easy  to 


326 


PRINCIPLES   OF  OSTEOPATHY. 


secure  enormous  leverage.  The  arms  can  be  used  as  levers 
while  the  physician's  knee  rests  against  the  kyphosis  as  in  Fig. 
113.  If  the  patient's  buttocks  are  held  to  the  stool,  the  whole 
force  of  the  leverage  is  spent  on  the  back  under  the  physician's 
knee.  This  movement  should  not  be  carried  too  far.  It,  like 
all  other  movements  in  which  the  physician  has  tremendous 
leverage,  is  liable  to  produce  more  than  the  desired  effect.  It 
stretches  the  thorax  and  abdomen  very  decidedly. 


Fig.   116. — A  method  of  affecting  either  lordosis  or  kyphosis  in  the  lumbar  region. 

Centra-indications. — The  author  expects  that  all  who 
use  this  and  other  high  power  movements,  have  examined 
their  patients  carefully  before  administering  them.  The 
presence  in  the  abdomen  of  an  aneurism,  ovarian  cyst,  or 
gravid  uterus,  contra-indicate  the  use  of  any  movement  which 
compresses  the  abdominal  contents,  and  also  in  the  case  of  a 
gravid  uterus  any  movement  which  is  liable  to  cause  active 
congestion  of  the  lumbar  enlargement  of  the  spinal  cord. 

Other  Movements. — Fig.  114  illustrates  another  meth- 
od of  exerting  pressure  on  the  prominent  part  of  a  kyphosis. 


PRINCIPLES   OF  OSTEOPATHY. 


327 


The  leverage  is  not  so  great  as  in  the  preceding  method,  but 
where  the  kyphosis  is  slight,  it  is  the  better  movement. 

Still  another  simple  method  of  springing  the  lumbar  por- 
tion of  the  spinal  column  is  shown  in  Fig.  115.  The  patient's 
knees  are  held  against  the  physician's  abdomen,  while  the 
physician's  hands  make  counter  pressure  over  the  apex  of  the 
kyphosis.  The  buttocks  are  forced  backward  by  the  pressure 


Fig.    117. — A    method    of    securing    general    dorsal    ro&tion. 

on  the  patient's  knees.  Some  osteopaths  object  to  this  move- 
ment or  any  other  which  necessitates  pressure  of  the  patient's 
knees  or  elbows  against  the  abdomen.  There  is  an  element 
of  danger  to  the  osteopath. 

This  position,  Fig.  115,  is  used  frequently  where  strong 
inhibitory  pressure  in  the  lumbar  region  is  required.  For 
example,  in  cases  of  diarrhoea  or  cramps.  Any  hyperactivity 


328 


PEINCIPLES  OF  OSTEOPATHY. 


Fig.    1 1 8. — A  case   of   uncompensated .  lateral  curvature. 

of  structures  governed  by  cells  in  the  lumbar  enlargement 
may  be  inhibited  in  this  region. 

When  lordosis  of  the  lumbar  region  exists,  it  is  neces- 
sary to  flex  that  region  in  order  to  counteract  it.  Fig.  116  il- 
lustrates an  easy  method  of  accomplishing  this  result. 

This  same  movement  with  the  physician's  right  hand 
under  the  spine  can  be  made  to  do  duty  in  correcting  a  pos- 


PRINCIPLES  OF  OSTEOPATHY.  329 

terior  curve.  When  the  hand  is  placed  directly  under  the 
kyphosis,  the  back  is  lifted ;  then  if  the  buttocks  be  forced  to 
the  table,  the  spine  will  be  sprung  in  the  direction  desired. 

Dorsal  Rotation. — Fig.  117  is  a  simple  method  of  se- 
curing flexibility  in  the  lower  dorsal  portion  of  the  back.  Ro- 
tation is  possible  in  the  dorsal  but  not  in  the  lumbar  region, 
hence,  by  holding  the  shoulders  down  and  lifting  one  hip,  rota- 
tion is  secured  in  the  dorsal  region.  This  movement  forces  the 
normal  action  between  individual  vertebrae  of  the  lower  dor- 
sal region.  If  any  particular  articulation  is  at  fault,; it  will 
not  yield  to  such  a  general  movement  as  this.  The  only  gain 
made  by  it  in  that  case  is  to  prepare  the  surrounding  tissues 
for  more  specific  work. 

Lateral  Curvature. — This  kind  of  deformity  is  fre- 
quently found  and  a  large  proportion  of  such  cases  are  bene- 
fited by  osteopathic  manipulation.  These  curves  are  developed 
as  a  result  of  improper  sitting.  A  weakened  condition  of  the 
whole  .body  predisposes  to  the  formation  of  a  late'ral  curve. 
Fig.  118  illustrates  an  uncompensated  lateral  curve,  that  is, 
the  curvature  is  all  in  one  direction.  In  such  a  case  the 
muscles  on  the  convex  side  are  not  doing  their  full  duty.  The 
patient  is  allowing  the  weight  of  the  upper  portion  of  the 
trunk  to  be  held  by  the  ligaments  instead  of  the  muscles.  This 
simple  curvature  can  be  readily  overcome  by  exercises  which 
will  develop  the  weak  spinal  muscles. 

Fig.  119  illustrates  a  compensated  curve,  that  is,  a  letter 
S  curve.  The  primary  curve  is  in  the  interscapular  region 
and  is  compensated  for  by  a  curve  in  the  opposite  direction  in 
the  lumbar  region.  This  case  is  much  more  deep-seated  than 
the  previous  one.  This  child  was  plump,  but  very  weak. 
There  were  some  symptoms  of  inflammation  of  the  fifth,  sixth 
and  seventh  vertebrae.  This  case  requires  manipulation  which 
will  twist  the  vertebrae  in  a  direction  opposite  to  their  present 
tendency.  The  manipulation  must  be  centered  on  the  affected 
vertebrae.  Extension  of  the  spine  will  also  be  beneficial. 
Voluntary  exercises  should  be  taken  gradually  to  strengthen 
the  muscles. 

Know     How     to     Apply     Principles. — The    osteopath 


330 


PRINCIPLES  OF  OSTEOPATHY. 


should  know  how  to  apply  his  principles  so  thoroughly  that 
the  position  of  his  patient,  whether  lying,  sitting  or  standing, 
will  not  confuse  him.  Some  osteopaths  desire  to  give  their 
manipulations  to  the  patient  sitting,  others  like  the  reclining 
position  better.  On  the  whole,  it  seems  best  to  select  the  po- 
sition suited  to  the  special  work  required. 

Do  Not  Copy  Movements. — Do    not    copy    anybody's 
movements.      Learn   the  principles,   then  apply   them   in   the 


Fig.    119.- — A  case  of  compensated  lateral  curvature. 

manner  most  satisfactory  to  yourself  and  helpful  to  the  pa- 
tient. To  understand  the  principles  and  apply  them  intelli- 
gently, one  cannot  know  too  much  concerning  all  the  subjects 
which  are  the  basis  of  a  broad  medical  education.  I  do  not 
mean  by  this  that  the  student  is  to  waste  any  time  on  drugs. 
From  the  osteopathic  standpoint,  drugs  are  not  a  part  of  the 
basis  of  a  medical  education. 


PRINCIPLES   OF   OSTEOPATHY.  331 

CHAPTER  XVIII. 


REDUCTION    OF    SUBLUXATIONS. 

Having  noted  a  few  movements  which  have  a  general  ben- 
eficial effect  on  groups  of  structures,  we  will  now  examine  a 
few  of  the  movements  which  are  applicable  to  specific  subluxa- 
tions. 

In  the  chapter  on  Subluxation  in  the  theoretical  section  of 
this  volume,  we  called  attention  to  the  fact  that  "A  subluxation 
is  a  slight  abnormal  relation  between  bony  surfaces,  maintained 
by  uneven  contraction  in  opposing  groups  of  muscles  which 
control  the  articulation.  The  causes  of  the  contraction  are 
violence,  temperature  changes,  and  reflex  irritation.  A  reduc- 
tion is  secured  by  equalizing  vital  activity."  With  this  state- 
ment in  rnind,  we  will  study  first  the  lateral  subluxations  in  the 
dorsal  region. 

Lateral  Subluxation. — A  lateral  subluxation  is  possi- 
ble only  in  those  portions  of  the  spinal  column  where  the  for- 
mation of  the  articular  facets  allow  rotation.  The  cervical  and 
dorsal  are  the  regions  in  which  this  occurs.  Lateral  sub- 
luxation  is  most  common  in  the  articulations  of  the  atlas,  third 
cervical,  and  anywhere  in  the  dorsal  with  the  exception  of  the 
twelfth.  The  inferior  articular  facets  of  the  twelfth  are  lumbar 
in  character,  hence  allow  only  flexion,  extension  and  circum- 
duction. 

It  makes  no  difference  what  the  cause  of  the  lateral  sub- 
luxation  may  be,  the  uneven  contraction  of  muscles  is  the  final 
result,  hence  all  are  treated  in  the  same  manner. 

When  the  vertebral  spine  is  discovered  out  of  line  with 
those  above  and  below  and  tenderness  noted  on  its  prominent 
side,  we  are  disposed  to  consider  it  a  true  lesion,  an  irritant  to 
the  nervous  system.  Whether  it  is  the  result  of  accident,  cold 
or  reflexes  does  not  need  to  be  seriously  considered.  While 
it  exists,  it  is  a  continual  source  of  irritation  to  the  nervous  sys- 
tem, hence  should  be  removed  without  delay.  If  it  is  the  re- 
sult of  reflexes,  its  reduction  will  at  least  remove  one  disturb- 
ing factor  from  the  case. 


332 


PRINCIPLES   OF   OSTEOPATHY. 


The  prominent  side  of  the  spine  is  the  one  on  which  the 
muscles  are  contracted.  The  contracted  muscles  must  be 
those  which  are  holding  the  bone  in  its  mal-position.  In  order 
to  exert  this  influence,  they  must  be  attached  in  such  a  way  as 
to  move  the  bone  in  this  direction  when  they  act  normally. 


Fig.    120. — Surface  indication   of  a   lateral  subluxation. 

Their  present  condition  is  one  of  hyperactivity.  With  this 
line  of  reasoning,  any  articulation  can  be  examined,  the  pull 
of  its  muscles  determined  and  movements  made  in  accordance 
with  the  normal  action  of  these  muscles. 

In  Fig.  1 20  we  observe  the  subluxation  to  the  left  of  a 
mid-dorsal  vertebra.     Intrinsic  rotation  of  the  dorsal  spines  is 


PRINCIPLES   OF  OSTEOPATHY. 


233 


the  result  of  the  contraction  of  the  rotatores  spinae,  one  of 
the  fifth  group.  In  order  for  this  vertebra  to  remain  sublux- 
ated,  i.  e.,  more  rotated  than  any  of  its  fellows,  the  particular 
digitation  of  the  rotatores  spinae  attached  to  it  must  remain 
contracted  after  the  other  digitations  have  become  relaxed. 


Fig.    121.      "Exaggeration"    of   a    lateral    subluxation. 

The  work  laid  out  for  us  is  relaxation  of  this  one  digitation. 
The  digitation  which  is  acting  is  working  from  below,  i.  e., 
arises  from  the  transverse  process  of  the  vertebra  below  the 
one  which  is  subluxated. 

The  first  movement  consists  in  "exaggerating  the  lesion." 
The  patient's  body  is  flexed  laterally  away  from  the  promi- 
nent side  of  the  lesion  as  in  Fig.  121.  This  procedure  stretches 


334  PRINCIPLES  OF  OSTEOPATHY. 

the  contracted  rotatores  spinae  and  also  separates  the  three 
vertebrae,  i.  e.,  the  subluxated  one  and  the  superior  and  in- 
ferior ones,  thus  making  it  easier  to  push  the  subluxated  ver- 
tebra into  its  true  position. 


Fig.    122. — "Flexion"   of   a   lateral   subluxiation. 

The  second  movement  is  an  anterior  flexion  to  permit 
of  greater  freedom  of  movement  between  the  articular  pro- 
cesses. By  forcing  the  body  first  into  the  position  of  lateral 
flexion,  then  anterior  flexion,  all  the  muscles  of  the  fifth 
group  which  affect  the  subluxated  vertebra  are  relaxed.  Dur- 
ing this  anterior  flexion,  a  "click"  is  sometimes  heard  which 
is  evidence  of  relaxation  sufficient  to  allow  approximation  of 


PRINCIPLES   OF   OSTEOPATHY. 


335 


the  subluxated  surfaces.  During  all  the  time  of  making  these 
flexions,  the  physician's  right  thumb  should  make  steady 
pressure  agaiast  the  prominent  side  of  the  spine,  thus  taking 
advantage  of  the  relaxation  gained  by  each  flexion.  The  an- 
terior flexion  is  illustrated  in  Fig.  122. 


Fig.    123. — Extension    and    counter    pressure-lateral    subluxation. 

The  final  movement  is  lateral  flexion  toward  the  lesion 
while  lifting  the  patient  from  the  stool  in  such  a  way  that  the 
weight  of  the  body  below  the  lesion  exerts  its  influence  to 
separate  the  vertebrae.  Fig.  123.  Counter  pressure  with  the 
thumb  is  made  vigorously  during  this  final  movement. 


336 


PRINCIPLES   OF   OSTEOPATHY. 


The  successful  reduction  of  this  subluxation  may  be  ac- 
complished without  any  "click"  or  other  evidence  of  movement 
of  the  surfaces.  The  vertebra  usually  moves  into  its  true  po- 
sition without  any  audible  sign.  The  physician's  fingers  can 
determine  the  success  or  failure  of  the  movement.  If  the  sub- 
luxation  were  caused  by  accident  or  cold,  its  reduction  is  all 


Fig.     124. — Leverage    applied    to    a    lateral    subluxation    in    the    mid-dorsal    region. 

that  is  needed,  but  if  it  is  the  result  of  reflex  irritation  orig- 
inating in  a  viscus,  the  physician  must  direct  such  a  mode  of 
living  that  rest  may  be  secured  for  the  stimulated  viscus.  Hab- 
its of  life  must  be  looked  into. 

Fig.  124  illustrates  another  method  of  reducing  a  slight 
lateral   subluxation.     The  physician's  left  arm  passes  under 


PRINCIPLES  OF  OSTEOPATHY.        .  337 

the  patient's  left  axillary,  then  the  hand  is  placed  firmly  on 
the  base  of  the  neck  posteriorly.  This  gives  the  physician 
great  leverage.  The  physician's  knee,  right  or  left,  is  placed 
against  the  spinal  column  at  a  point  four  or  five  inches  below 
the  subluxation.  This  compels  the  flexible  spinal  column  to 
yield  to  the  force  applied  at  the  neck,  in  such  a  way  as  to  relax 
the  deep  muscles  controlling  the  subluxation.  Counter  pres- 
sure applied  to  the  prominent  spine  by  the  physician's  right 
thumb  completes  the  movement.  By  this  movement  about  the 
same  result  is  obtained  as  when  counter  extension  is  given  by 
two  men  pulling  at  the  head  and  feet  of  the  patient,  while  a 
third  one  devotes  his  attention  to  forcing  the  vertebral  spine 
into  place.  When  the  patient  is  short  and  heavily  muscled, 
it  is  impossible  to  execute  this  movement  satisfactorily. 

Lateral  Subluxation — Lower  Dorsal. — A  lateral  lesion 
of  the  ninth,  tenth  or  eleventh  dorsal  is  more  easily  handled 
than  those  higher  up,  because  the  physician  can  grasp  the 
patient  in  a  much  more  satisfactory  manner.  Fig.  125  illus- 
trates the  method. 

The  series  of  movements  are  always  the  same  as  already 
described,  that  is,  lateral  flexion  or  "exaggeration,"  anterior 
flexion,  then  lateral  flexion  toward  the  lesion  as  illustrated  by 
the  cut. 

With  this  same  position,  other  forms  of  subluxation  in 
the  lower  dorsal  and  lumbar  regions  can  be  corrected. 

A  Depressed  Spine. — Slight  depression  of  a  dorsal 
spine  with  sensitiveness  over  it,  that  is,  between  its  apex  and 
the  spine  below,  indicates  that  the  muscles  in  that  situation  are 
sufficiently  contracted  to  draw  the  spine  of  the  upper  vertebra 
downward.  The  depressed  spine  indicates  that  the  body  of  the 
vertebra  is  slightly  tipped  backward  and  downward.  See  chap- 
ter on  Subluxations. 

To  reduce  this  lesion,  a  flexion  of  the  spinal  column  as 
far  as  the  vertebra  below  is  made  anteriorly.  If  the  depressed 
spine  is  any  one  of  the  upper  six  dorsal,  use  the  pull  of  the 
splenius  capitis  et  colli,  i.  e.,  flex  the  head  and  neck  as  in  Fig. 
n.  The  physician's  right  hand  is  placed  on  the  spine  of  the 
vertebra  below  the  subluxation,  thus  allowing  all  the  force 


338 


PKINCIPLES  OF  OSTEOPATHY. 


Fig.    125. — Leverage   applied    to   a   lateral    subluxation    in   the    lower   dorsal    region. 

of  the  movement  to  terminate  in  a  pull  on  the  muscles  be- 
tween this  vertebra  and  the  depressed  spine.  This  same  prin- 
ciple can  be  applied  to  all  portions  of  the  spinal  column. 

When  individual  spines  are  prominent,  and  sensitiveness 
is  found  above  the  process  instead  of  below,  we  have  a  condi- 
tion the  reverse  of  that  just  described.  Its  treatment  is  sim- 


PRINCIPLES   OF   OSTEOPATHY.  339 

ilar  to  that  of  the  preceding,  except  that  by  changing  the  po- 
sition of  the  right  hand  to  rest  upon  the  prominent  spine,  our 
leverage  affects  the  contracted  muscles  above  the  spine. 

Kyphosis — Pott's  Disease. — Whenever  a  "knuckle"  is 
found  in  the  spine,  inquire  carefully  as  to  the  possibility  of 
direct  injury,  predisposition  to  tuberculosis,  etc.  Pott's  dis- 
ease of  the  spinal  column  causes  prominence  of  a  single  ver- 
tebral spine.  As  other  vertebrae  are  affected,  a  kyphosis  is 
developed. 

According  to  the  principles  written  by  Dr.  Hilton,  in  his 
volume  on  "Rest  and  Pain,"  there  should  be  perfect  rest  in  a 
case  of  spinal  caries.  His  idea  of  a  cure  is  ankylosis.  The 
osteopathic  principle  is  directly  opposed  to  the  idea  of  rest. 
As  has  been  stated  before  in  these  pages,  flexibility  is  the  key- 
note of  health,  because  a  perfect  circulation  can  exist  only 
where  free  movement  is  maintained. 

The  predisposing  cause  of  Pott's  disease  is  a  strain  or 
bruise  of  a  vertebral  articulation  which  results  in  the  hyper- 
aemia  of  repair.  Muscular  contraction  occurs  as  a  reflex  ef- 
fort of  nature  to  hold  the  parts  quiet.  This  muscular  con- 
traction finally  becomes  a  menace  to  the  life  of  the  parts  which 
are  being  held  by  it,  that  is,  it  obstructs  the  free  drainage  of 
the  injured  part.  Further  destruction  of  tissue  is  favored  by 
the  lack  of  drainage  occasioned  by  the  loss  of  mobility. 

There  are  many  people  with  rigid,  deformed  joints  whc 
are  living  examples  of  the  fixation  theory  as  applied  in  sur- 
gical practice.  Ten  years  is  scarcely  time  enough  in  which 
to  show  a  sufficient  number  of  cases  successfully  handled  ac- 
cording to  osteopathic  principles.  Nevertheless,  quite  an  ar- 
ray of  cases  can  be  referred  to  as  evidence  of  successful  appli- 
cation of  principles  of  mobility. 

The  osteopathic  work  done  on  cases  of  spinal  caries  has 
demonstrated  that  when  passive  movement  of  the  involved  re- 
gion is  made,  so  as  to  free  the  venous  circulation,  the  work 
of  repair  is  immediately  started.  Time  is  the  essence  of  the 
contract  in  such  cases. 

The  author  has  seen  cases  of  spinal  caries  in  patients 
ranging  from  five  to  sixty  years  of  age.  The  oldest  was 


340  PKINCIPLES  OF  OSTEOPATHY. 

treated  with  as  much  success  as  the  youngest.  When  one  has 
seen  a  patient  sixty  years  of  age  suffering  from  spinal  caries 
to  the  extent  that  standing  or  sitting  without  support  of  a 
plaster  jacket  was  impossible,  and  the  slightest  weight  of  the 
body  would  cause  the  vertebrae  to  press  the  nerves  of  the 
lumbar  plexus  to  such  an  extent  that  the  pain  became  instantly 
unendurable ;  then  to  see  this  patient,  after  four  years'  of  os- 
teopathic  treatment,  able  to  ride  a  bicycle  and  the  plaster  cast 
thrown  aside,  one  cannot  be  blamed  for  expressing  enthusi- 
asm. 

I  have  examined  but  one  child  in  the  early  stages  of  Pott's 
disease.  It  seems  that  little  attention  is  paid  to  the  actions  of 
young  children  until  the  back  becomes  so  weak  and  deformed 
that  the  child  rests  his  hands  on  his  thighs  for  support.  In- 
variably a  brace  or  plaster  jacket,  usually  the  latter,  is  applied 
to  the  child  by  the  family  doctor. 

As  to  whether  or  not  a  brace  should  be  applied  is  an  open 
question  to  the  osteopath.  If  all  cases  could  be  put  under  the 
care  of  an  osteopath  before  the  caries  had  involved  more  than 
one  or  two  vertebrae,  slightly,  it  is  my  opinion  that  a  brace  is 
useless.  The  passive  movements  will  have  a  sufficient  effect 
to  start  the  process  of  repair  in  spite  of  the  compression  of 
the  vertebrae  by  the  weight  of  the  body.  In  cases  showing 
a  kyphosis,  involving  several  vertebrae,  and  where  the  patient 
cannot  stand  erect,  but  sustains  the  weight  by  the  help  of  the 
hands  on  the  thighs,  we  always  apply  a  brace ;  a  steel  brace, 
not  a  plaster  or  sole  leather  jacket.  This  sustains  the  patient 
when  exercising.  The  osteopathic  treatment  is  a  direct  ef- 
fort to  secure  flexibility  in  each  vertebral  articulation. 

Examination  should  determine  whether  a  collection  of  pus 
exists  along  the  anterior  surface  of  the  vertebrae.  If  the 
kyphosis  is  in  the  lower  dorsal  or  lumbar  regions,  examine 
carefully  through  the  abdominal  walls  for  the  outline  of  a 
collection  of  pus  in  the  sheaths  of  the  psoas  muscles.  Note 
the  length  of  the  legs,  condition  of  the  hip  joint,  temperature 
of  the  spine,  whether  fluctuation  can  be  shown  under  the 
origin  of  the  rectus  femoris.  If  much  pus  exists,  the  exam- 
ination of  these  joints  should  show  it. 


PRINCIPLES  OF  OSTEOPATHY.  341 

If  a  pus  sack  is  found,  do  not  treat  the  case  by  using  such 
heavy  movements  as  might  rupture  the  sack.  In  any  case  of 
Pott's  disease,  we  do  not  attempt  immediately  to  reduce  the 
deformity;  that  is  not  the  object  of  the  treatment,  and  should 
not  be  expected.  The  object  should  be  to  stop  the  disease 
process  and  have  it  leave  the  tissues  in  such  condition  that  the 
patient  can  move  them.  It  is  too  much  to  expect  the  restora- 
tion of  the  destroyed  bone  to  its  original  form. 

I  was  called  to  examine  a  case  of  Pott's  disease  which  had 
been  treated  osteopathically  for  six  months  previously.  The 
patient  showed  marked  signs  of  improvement  during  the  first 
month.  His  sole  desire  had  been  to  get  rid  of  the  deformity, 
hence  he  urged  his  physician  to  force  the  vertebrae  to  their 
normal  position.  With  the  help  of  an  assistant  this  was  par- 
tially done,  much  to  the  satisfaction  of  the  patient.  He  stood 
straighter  and  walked  better.  This  gain  was  only  temporary, 
because  the  severity  of  the  treatment  started  the  pus  to  col- 
lecting in  the  sheath  of  the  psoas  muscle,  and  at  the  time  of  my 
examination  had  gravitated  to  a  position  around  the  hip  joint. 
It  had  worked  its  way  from  the  lesser  trochanter  to  a  position 
behind  the  greater  trachanter.  Fluctuation  was  present.  I 
refused  to  treat  the  case.  There  was  a  fatal  termination  within 
a  few  months. 

I  always  refuse  cases  in  which  a  pus  sack  is  clearly  defined. 
Such  cases  are  beyond  control  by  manipulation.  There  may 
te  osteopaths  who  are  willing  to  handle  such  cases.  I  have 
not  seen  any  successfully  handled  after  the  stage  has  been 
reached  which  has  just  been  described. 

Counter  extension  of  the  spine  should  be  practiced  by  the 
patient's  relatives  at  least  every  night  and  morning.  Children 
should  be  compelled  to  rest  at  least  twice  a  day,  morning  and 
afternoon.  If  a  brace  is  deemed  advisable,  be  sure  it  fits  the 
patient  well.  Have  it  removed  during  the  rest  periods  and  at 
night.  See  that  it  does  not  cause  abrasions  of  the  skin. 

I  have  noted  here  the  good  and  bad  effects  of  the  applica- 
tion of  osteopathic  principles  to  this  disease,  so  that  the  stu- 
dent may  realize  that  each  case  must  be  examined  with  ex- 
treme care  before  anv  movements  are  made. 


342 


PRINCIPLES  OF  OSTEOPATHY. 


gnu 


Fig.    126. — A  method   of   spreading  the   lower   ribs  and   stretching  the   diaphra 

When  adhesions  are  forming  between  the  vertebrae  as  a 
result  of  the  inflammation,  the  use  of  such  movements  as  witf 
force  the  normal  movement  of  the  joint  are  indicated.  After 
a  treatment  is  given  which  breaks  up  one  of  these  adhesions, 
it  is  best  to  let  the  patient  rest  at  least  one  week.  Too  frequent 
treatments  keep  up  a  continual  irritation.  If  the  patient  is 


PRINCIPLES   OP  OSTEOPATHY.  343 

not  wearing  a  brace  at  all,  or  only  a  portion  of  the  time,  enough 
voluntary  movement  will  be  made  to  prevent  the  re-formation 
of  the  adhesion. 

If  a  brace  is  being  worn  most  or  all  of  the  time,  treatments 
should  be  given  at  least  three  times  a  week  in  order  to  keep 
up  the  relaxation. 

The  movements  outlined  heretofore  for  the  treatment  of 
general  spinal  conditions,  especially  kyphosis,  are  applicable 
in  the  treatment  of  Pott's  disease. 

Rib  Subluxations. — Rib  subluxations  present  many 
difficulties  to  the  osteopath.  The  methods  used  in  their  re- 
duction are  as  varied  as  can  well  be  imagined.  A  few  of  the 
most  useful  and  direct  are  given  here. 

In  Fig.  126  the  physician  is  applying  a  method  of  spread- 
ing the  lower  ribs.  When  the  tenth  rib  sinks  under  the  ninth 
and  there  is  a  general  jamming  of  the  four  lower  ribs  together, 
the  physician  stands  behind  the  patient  who  raises  his  hands 
above  his  head  to  spread  the  lower  ribs  by  means  of  the  latis- 
simus  dorsi.  While  the  hands  are  elevated,  the  physician  grasps 
the  anterior  extremities  of  the  ribs  and  holds  them  up  while 
the  patient  lowers  his  hands  to  his  thighs.  Such  a  movement 
as  this  will  replace  the  ribs  in  their  right  relations,  but  a  flex- 
ion of  the  patient's  body  will  undo  the  work.  Continual  well 
directed  treatment  and  voluntary  exercise  are  needed  to  bring 
them  to  place  and  hold  them  there. 

The  four  lower  ribs  can  be  separated  and  the  antero-poste- 
rior  diameter  of  the  thorax  increased  by  the  method  illustrated 
in  Fig.  127. 

The  left  hand  lifts  on  the  angles  of  the  depressed  ribs 
while  the  patient's  arm  is  extended  beyond  his  head,  thus  mak- 
ing use  of  the  leverage  gained  through  the  attachment  of  the 
latisimus  dorsi.  This  movement  increases  the  right  and  left 
hypochondriacal  spaces. 

The  position  of  an  individual  rib  is  affected  by  the  con- 
traction of  the  intercostal  muscles  above  and  below  it.  The 
spacing  determines  whether  the  rib  is  elevated  or  depressed. 
The  width  of  an  intercostal  space  will  not  be  the  same  be- 
tween the  angles  and  anterior  extremities.  This  is  caused  by 


344 


PRINCIPLES  OF  OSTEOPATHY. 


the  fact  that  the  head  of  the  rib  is  fixed  so  that  it  cannot  move 
up  or  down.  The  movement  which  takes  place  between  the 
head  of  the  rib  and  the  vertebra  is  a  slight  rotation.  The 
costo-transverse  articulation  allows  a  slight  gliding  of  the  ai- 
ticular  facet  of  the  rib  upon  that  of  the  transverse  processes. 
As  an  example,  take  the  fifth  rib,  when  the  space  between  it 
and  the  fourth  rib  is  lessened  bv  the  contraction  of  the  fourth 


Fig.   127. — Spreading  the  lower  ribs  by  using  the  latissimus  dorsi. 

intercostals.  The  lower  margin  of  the  rib  becomes  prominent 
because  the  rib  is  twisted  when  raised.  The  anterior  extrem- 
ity is  depressed,  making  the  fourth  intercostal  space  wider 
anteriorly.  Palpation  of  this  rib  in  this  condition  will  show 
a  prominent  angle  with  corresponding  depression  of  the  an- 
terior extremity.  When  the  rib  is  depressed  at  the  angle,  its 
anterior  extremity  will  be  prominent. 

Palpation  is  the  only  method  of  discovering  these  sub- 


PEIXCIPLES  OF   OSTEOPATHY. 


345 


Fig.   128. — First  position  to  reduce  a  subluxated  fifth  rib. 

luxations.  To  reduce  them,  the  same  principle  we  applied  to 
reduction  of  vertebral  subluxations  must  be  applied  here,  i.  e., 
the  relaxation  of  the  contracted  muscles. 


346 


PRINCIPLES  OF  OSTEOPATHY. 


Fig.    129. — Second    position    to    reduce    a    subluxated    fifth    rib. 

The  tendency  in  asthmatic  and  bronchitic  patients  is  to 
cause  elevation  of  the  ribs,  thus  developing  a  barrel-shaped 
chest.  When  all  the  intercostal  muscles  act  equally,  the  ribs 
are  equally  spaced,  but  in  a  case  of  bronchitis,  some  local  por- 


PRINCIPLES   OF   OSTEOPATHY.  347 

tion  of  the  bronchial  tubing  is  especially  irritated.  From  this 
area,  irritant  impulses  reach  the  spinal  center  with  which  it 
is  most  closely  associated.  The  intercostal  muscles  in  direct 
relation  with  this  center  receive  a  greater  number  of  impulses, 
hence,  contract  more  vigorously.  A  strain  or  blow  might  cause 
the  same  result. 

To  bring  this  fifth  rib  down  to  its  proper  position,  the 
physician  may  stand  behind  his  patient  as  is  illustrated  by  Fig. 
128.  His  left  hand  grasps  the  patient's  right  elbow  and  pushes 
it  above  the  shoulder,  thus  causing  the  muscles  to  lift  the  ribs. 
This  movement  will  pull  on  all  the  ribs  of  the  right  side,  and 
tend  to  equalize  the  spacing.  The  physician  places  his  left 
knee  directly  over  the  angle  of  the  fifth  rib,  his  right  hand  on 
the  anterior  extremities  of  the  fifth,  sixth  and  seventh  ribs, 
the  middle  finger  of  this  hand  being  applied  against  the  lower 
margin  of  the  fifth  rib.  The  rib  being  now  in  right  relation 
with  its  fellows,  the  critical  period  of  the  movement  is  when 
relaxation  is  allowed  by  lowering  the  arm.  The  knee  above 
and  over  the  angle,  pressing  forward  and  downward,  while  the 
middle  finger  of  the  right  hand  prevents  depression  of  the 
anterior  extremity.  This  leverage  forces  the  rib  to  retain  right 
relations  with  its  fellow  in  relaxation  of  the  chest.  The  ter- 
mination of  the  movement  is  illustrated  by  Fig.  129. 

A  general  depression  of  all  the  angles  of  the  ribs  causes 
their  superior  margins  to  be  prominent.  A  flat  chest  is  the 
result.  This  condition  frequently  follows  pneumonia  or  some 
disease  which  causes  the  patient  to  lie  on  the  back  during  a 
long  period  of  weakness. 

When  a  single  depressed  rib  is  found,  it  usually  has  been 
caused  by  a  strain  which  has  weakened  the  intercostal  muscles 
in  the  space  above  it.  Treat  it  while  standing  in  front  of  the 
patient.  Place  the  middle  finger  of  the  left  hand  under  the 
angle.  The  patient's  right  elbow  may  rest  against  the  phy- 
sician's abdomen.  Pressure  made  on  the  elbow  forces  the 
scapula  back  and  brings  into  action  the  serratus  magnus  which 
lifts  the  ribs.  Ask  the  patient  to  inspire  and  this  will  raise 
all  the  ribs.  When  relaxation  comes  with  expiration,  lift  the 
angle  of  the  rib  forcefully,  and  it  will  regain  its  proper  posi- 


348 


PRINCIPLES  OF  OSTEOPATHY. 


Fig.  130. — The  position  of  the  fingers  below  the  angle  of  a  depressed  rib. 

tion.  Fig.  130  illustrates  this  movement.  Some  osteopaths 
grasp  the  patient's  right  wrist  and  extend  the  arm  first  for- 
ward, then  above  the  head,  and  back  to  the  side,  instead  of 
placing  the  patient's  elbow  against  the  abdomen. 

It  will  be  noted  that  all  these  movements  are  based  on  the 
effects  of  muscular  contraction  and  relaxation  with  resulting 


PRINCIPLES   OF  OSTEOPATHY. 


349 


changes  of  the  position  of  the  structures  to  which  they  are  at- 
tached. 

Figs.  131,  132  and  133  illustrate  the  method  of  raising 
and  spreading  the  lower  ribs.  With  the  patient  in  this  posi- 
tion, the  physician  can  make  extensive  passive  movements 


Fig.  131. — The  first  position  in  lifting  a  series  of  depressed  lower  ribs. 

without  much  resistance.    These  movements  are  similar  to  that 
illustrated  by  Fig.  126. 

When  the  ribs  "droop"  to  a  marked  degree,  there  is  a 
decided  change  in  the  shape  of  the  diaphragm.  The  extent 
of  the  thoracic  floor  is  lessened,  and  it  may  be  that  the  struct- 
ures passing  through  the  diaphragm  are  detrimentally  af- 


350 


PRINCIPLES   OF   OSTEOPATHY. 


Fig.  132. — The  second  position  in  lifting  a  series  of  depressed  lower  ribs. 

fected  by  it.  The  movement  pictured  in  Fig.  126  is  well  cal- 
culated to  spread  the  lower  ribs  and  thereby  increase  respira- 
tory capacity. 

The  first  rib  is  so  strongly  held  by  the  scalenus  anticus 
that  it  practically  never  is  depressed.  It  is,  however,  fre- 
quently elevated  to  such  an  extent  that  it  infringes  on  struct- 


PRINCIPLES   OF  OSTEOPATHY. 


351 


Fig.    133. — The  third  position   in   lifting  a   series  of  depressed  lower   ribs. 

ures  around  the  first  thoracic  sympathetic  ganglion,  thus  affect- 
ing heart  action. 

To  depress  the  first  rib  to  its  proper  position,  it  is  nec- 
essary to  take  the  extra  contraction  out  of  the  scalenus  anticus. 
This  is  done  by  making  the  first  rib  a  fixed  instead  of  a  mov- 
able attachment.  Fig.  140  illustrates  the  method  of  relaxing 
the  scalenus  anticus.  The  physician's  thumb  holds  the  first 


352 


PRINCIPLES  OF  OSTEOPATHY. 


rib  down  while  the  muscle  is  stretched  by  forcing  the  patient's 
head  directly  to  the  opposite  side.  The  scaleni  muscles  can 
be  easily  detected  by  placing  one's  fingers  on  the  side  of  the 
neck  near  the  base.  They  will  be  felt  hardening  during  in- 
spiration. 

Luxations  of  the  Innominate  Bones. — Examination  of 
the  innominate  bones  requires  very  close  observation  of  all  the 
factors  concerned  in  tilting  the  pelvis  and  varying  the  length 
of  the  lower  extremities. 


Fig.    134. — Position  for  treatment  of  an  upward  and   forward  dislocation 
of  the  ilium. 

We  have  noted  the  immobility  of  the  sacro-iliac  articula- 
tions, in  a  previous  chapter.  Unless  a  decided  accident  has 
been  experienced  by  the  patient,  it  is  hardly  conceivable  that 
the  innominates  and  sacrum  could  have  their  relations  dis- 
turbed. 

All  the  cases  of  luxation  of  the  innominate  which  we  have 
examined  in  clinic  and  private  practice  presented  a  very  vivid 
history  of  severe  accident.  The  symptoms  were  principally 
those  of  pain,  muscular  tension  and  joint  stiffness  in  the  ex- 


PKIXCTPLES   OF  OSTEOPATHY. 


353 


tremity  on  the  affected  side.  Two  cases  of  luxated  innomi- 
nate in  females  gave  no  signs  of  disturbed  pelvic  viscera,  al- 
though we  would  expect  decided  disturbance  in  that  region. 
The  only  way  to  determine  the  condition  of  the  innomi- 
nates  is  by  palpation  and  mensuration.  Have  the  patient 
stripped  and  sitting  in  a  perfectly  upright  position  on  a  level 
surface.  Determine  the  condition  of  the  lumbar  portion  of 
the  spinal  column.  Have  the  patient's  shoulders  level.  "While 
the  patient  is  in  this  position  the  relative  prominence  of  the 


Fig.    135. — A    dangerous    method   of   applying    force    to    the    sacro-iliac    articulation. 

posterior  superior  iliac  spines  can  be  noted  by  palpation.  Find 
the  second  sacral  spine  and  note  the  relations  of  the  iliac 
spines  to  it.  They  should  all  be  on  a  level.  See  Fig.  54  in 
chapter  VIII.  Palpate  for  sensitiveness  around  the  iliac 
spines,  crests  of  the  ilia  and  crests  of  pubes.  Measure  from 
the  anterior  superior  iliac  spines  to  the  adductor  tubercles  on 
the  internal  condyles  of  the  femur,  when  the  patient  rests 
evenly  in  the  dorsal  position.  This  measurement  is  not  en- 
tirely satisfactory,  because  any  change  in  the  thigh  muscles 
or  hip  rotators  may  easily  vary  the  measurements.  The  only 


354 


PRINCIPLES  OF  OSTEOPATHY. 


fixed  structures  from  which  a  reckoning  can  be  made  are  the 
second  sacral  and  posterior  superior  iliac  spines.  The  rela- 
tions between  the  sacrum  and  ilium  are  never  greatly  changed, 
therefore  it  requires  the  examiner  to  exclude  practically  all 
measurements  which  might  be  varied  by  muscular  tension. 


Fig.    136. — First   position   to    raise    the   clavicle. 

The  posterior  superior  iliac  spine  may  be  less  prominent 
than  its  fellow  on  the  opposite  side,  or  vice  versa.  There  may 
not  be  enough  upward  or  downward  displacement  to  make  a 
well  recognized  change  in  horizontal  relations  with  the  second 
sacral  spine.  This  being  the  case,  it  is  decidedly  difficult  to 
determine  which  side  is  normal  and  which  is  abnormal.  Hy- 
per aesthesia  will  have  to  be  depended  on  to  determine  this 


PRINCIPLES  OF  OSTEOPATHY. 


355 


point.     The  related   subjective  symptoms  of  the  patient  will 
decide  which  is  the  affected  side. 

The  shock  which  is  transmitted  to  this  articulation  in 
an  accident  usually  strikes  the  tuber  ischii  from  below,  or  pos- 
teriorly, or  strikes  the  knee  and  the  force  is  exerted  against 
the  ascetabulum.  When  the  force  is  against  the  tuber  ischii 


Fig.   137- — Second  position  to  raise  the  clavicle. 

from  below,  or  posteriorly,  we  have  an  upward  displacement, 
or  a  twist,  causing  the  posterior  superior  iliac  spine  to  become 
more  prominent.  When  the  force  strikes  the  ascetabulum  by 
means  of  the  femur,  the  twist  is  in  the  opposite  direction,  and 
the  spine  is  less  prominent. 

Have  the  patient  give  details,  if  possible,  concerning  his 


356 


PRINCIPLES  OF  OSTEOPATHY. 


position  with  reference  to  the  direction  of  the  force  at  the  time 
of  the  accident. 

Having  determined  the  direction  of  the  twist,  the  force 
of  our  manipulation  must  be  made  counter  to  that  applied  at 
the  time  of  the  accident.  Since  the  hip  joint  is  very  movable, 
we  cannot  use  the  thigh  as  a  stiff  lever,  therefore,  our  force 
must  be  applied  to  either  the  anterior  or  posterior  surface  of 


Fig.    138. — Relaxation   of   the    cervical    fibers    of    the    trapezius. 

the  tuber  ischii  and  to  the  anterior  or  posterior  superior  spine 
of  the  ilium,  i.  e.,  push  and  pull,  such  as  turning  a  wheel  on 
its  axle.  This  movement  is  illustrated  in  Fig.  134.  The  orig- 
inal force  which  this  movement  is  trying  to  overcome,  was 
transmitted  from  the  knee  by  the  femur  to  the  acetabulum,  and 
resulted  in  a  twist  of  the  ilum  which  made  the  posterior  su- 
perior spine  less  prominent  than  its  fellow  of  the  opposite 
side.  In  order  to  make  this  movement  effectual,  an  assistant 


PRINCIPLES   OF   OSTEOPATHY. 


357 


must  make  steady,  even  pressure  over  the  articulation  of  the 
sacrum  and  fifth  lumbar  vertebra,  i.  e.,  overcome  the  tendency 
of  the  twisting  movement  to  merely  affect  the  movable  sacro- 
vertebral,  instead  of  the  immovable  sacro-iliac  articulation. 

By  flexing  the  patient's  thigh  on  to  his  abdomen,  sufficient 
opportunity  is  given  the  physician  to  make  pressure  on  the  an- 
terior surface  of  the  tuber  ischii,  and  pull  forward  on  the  pos- 


Fig.   139- — Relaxation  of  the  sterno-cleido-mastoid. 

terior  superior  iliac  spine,  thus  reversing  the  movement  illus- 
trated by  Fig.  134. 

Fig.  135  illustrates  an  effort  to  use  the  thigh  as  a  lever 
to  effect  the  sacro-iliac  articulation  when  the  posterior  superior 
spine  is  prominent.  This  is  a  dangerous  movement,  and  should 
not  be  used.  The  force  transmitted  by  the  thigh  as  a  lever 
will  not  reach  the  joint  desired,  and  will  only  result  in  straining- 
the  ilio-femoral  ligament. 


358 


PRINCIPLES  OF  OSTEOPATHY. 


CHAPTER  XIX. 


TREATMENT  OF  THE  CERVICAL  REGION. 

The  treatment  of  the  clavicles  must  be  considered  here, 
because  their  position  so  frequently  interferes  with  the  drain- 
age of  the  tissues  of  the  neck.  When  it  is  held  down  too  close 
to  the  first  rib  by  shortening  of  the  subclavius  muscle,  it  is 


Fig.    140. — Relaxation   of  the   scalen:   by   depressing  the   first    rib. 

quite  sure  to  affect  venous  circulation  in  the  head  and  neck. 
To  raise  the  Clavicle. — To  raise  it  place  the  right 
thumb  on  the  first  rib  as  is  illustrated  by  Fig.  136,  then  carry 
the  patient's  left  forearm  across  his  face  above  the  head  as  in 
Fig-  137.  Then  as  far  outward  as  the  physician's  arm.  This 


PRINCIPLES   OF   OSTEOPATHY. 


359 


movement  causes  the  clavicle  to  press  down  on  the  physician's 
thumb,  where  it  rests  on  the  first  rib,  and  thus  stretches  the 
subclavius. 

Subluxation  of  the  Clavicle. — Articulations,  such  as 
the  sterno-clavicular  and  acromio-clavicular,  which  depend  en- 
tirely on  their  ligaments  to  keep  them  together  and  to  limit 
their  motion,  cannot  be  retained  in  place  if  their  ligaments 


Fig.    141. — Relaxation  of  the  splenius  capitis  et  colli. 

have  been  injured.  If  the  ligaments  of  the  sterno-clavicular 
joint  becomes  relaxed,  the  pull  of  the  sterno-cleido-mastoid 
lifts  it  upward.  Slight  irritation  of  the  pneumogastric  nerve 
may  be  occasioned  by  this  change  of  position. 

Preparatory  Treatment  of  the  Neck — Trapezius. — The 
preparatory  treatment  of  the  neck  consists  in  movements  to 


360  PRINCIPLES  OF  OSTEOPATHY. 

relax  the  various  groups  of  muscles.  Fig.  138  illustrates  the 
method  of  relaxing  the  cervical  portion  of  the  trapezius.  One 
hand  on  the  shoulder  holds  it  firmly  down,  while  the  other 
hand  forces  the  head  as  far  as  possible  in  the  opposite  direc- 
tion. Relax  the  opposite  muscle  in  a  similar  manner. 

Sterno-cleido-mastoid. — Next,  relax  the  sterno-cleido- 
mastoid  by  separating  its  attachments  as  far  as  possible,  as  in 
Fig.  139,  also  by  direct  manipulation.  Observe  whether  both 


Fig.   142. — Extension  of  the  neck. 

muscles  will  relax  equally.  These  large  muscles  are  fre- 
quently found  unevenly  contracted.  Since  the  spinal  acces- 
sory nerves  control  these  muscles,  any  contraction  should  lead 
the  physician  to  examine  all  parts  in  connection  with  them.  A 
reflex  from  the  laryngeal  branches  as  well  as  pneumogastric 
branches  might  account  for  it. 

Scaleni. — The  scaleni  muscles  should  be  treated  as  al- 
ready mentioned  in  Chap.  XVIII.     See  Fig.  140. 


PRINCIPLES  OF  OSTEOPATHY.  361 

Splenius  Capitis  et  Colli. — Fig.  141  illustrates  a  meth- 
od of  stretching  the  ligamentum  nuchae  as  well  as  all  the  ex- 
tensor muscles  on  the  back  of  the  neck.  This  may  be  mod1'- 
fied  by  forcing  the  chin  backward  with  one  hand,  while  th<* 
other  flexes  the  head  as  sharply  as  possible.  This  stretches 
the  muscles  and  ligaments  on  the  posterior  portion  of  the 
occipital-atlantal  and  axial  articulations.  The  retraction  of  the 
chin  governs  the  amount  of  stretching  exerted  by  the  flexion.. 


Fig.     143. — Position     for    circumduction     of     the     neck     to     relax    the    muscles    of 

the  fifth  layer. 

Extension. — Direct  extension  of  the  neck  makes  an 
equal  pull  on  all  the  vertebrae.  When  the  patient's  feet  are 
anchored,  the  force  of  the  pull  is  felt  in  the  weakest  portions 
of  the  spinal  column.  The  average  patient  requiring  this 
treatment  enjoys  a  delicious  stimulation  after  relaxation  of 
the  extension.  A  few  who  are  extremely  nervous  may  give  a 
bad  reaction.  The  influx  of  blood  in  the  spinal  cord  is  highly 
beneficial  to  those  who  have  sufficient  vaso-motor  tone  to  hold 


362 


PRINCIPLES   OF   OSTEOPATHY. 


it  there,  but  those  who  lack  this  tone  will  feel  faint  or  even 
absolutely  lose  consciousness.  Simply  allowing  them  to  rest 
on  the  table  until  the  vascular  system  reacts,  will  enable  them 
to  reap  the  full  benefit  of  the  treatment.  The  extension  should 
be  made  with  absolute  steadiness.  The  relaxation  period  is 
usually  the  one  in  which  any  vaso-motor  phenomena  are  noted. 
The  tension  should  be  lessened  very  slowly  in  all  cases.  Pig. 
142  shows  the  position  of  the  physician's  hands. 


Fig.   144. — Relaxation  of  the  stylo-hyoid  and  posterior  belly  of  the  digastric. 

Rotation. — The  following  movement  is  one  for  which  long 
practice  is  required  in  order  to  get  anything  like  a  successful 
result  from  its  use.  It  consists  in  grasping  the  patient's  neck 
with  the  left  hand  as  in  Fig.  143.  The  patient's  head  rests 
against  and  slightly  to  the  right  of  the  physician's  forearm. 


PRINCIPLES  OF  OSTEOPATHY. 


363 


The  right  hand  grasps  the  chin  while  the  forearm  rests  firmly 
against  the  patient's  head.  The  object  is  to  hold  the  neck  and 
head  rigid  above  the  point  grasped  by  the  thumb  and  fingers 
of  the  left  hand.  While  holding  the  head  and  neck  rigid,  they 
are  moved  so  as  to  force  circumduction  in  the  joint  below  the 


Fig.    145. — Relaxation  of  the  mylo-hyoid  and  hyo-Rlossus. 

grasp  of  the  left  hand.  After  each  circumduction  the  left  hand 
is  shifted  the  depth  of  one  vertebra  nearer  the  head.  Thus  all 
the  intervertebral  articulations  in  the  cervical  region  are  re- 
laxed and  specific  work  on  a  definite  articulation  can  be  done 
more  easily. 

The   Hyoid   Bone. — Work   on   the  anterior  portion  of 
the  neck  consists  in  affecting  the  condition  of  groups  of  mus- 


364  PRINCIPLES  OF  OSTEOPATHY. 

•cles  forming  the  floor  of  the  mouth  and  extrinsic  muscles  of  the 
larynx. 

The  Hyoid  bone  is  the  movable  part  which  can  be  grasped 
by  the  physician's  fingers.  Drawing  it  downward  and  to  the 
right,  as  in  Fig.  144  relaxes  the  stylo-hyoid  and  posterior  belly 
of  the  digastric.  A  contractured  condition  of  these  muscles 
may  affect  the  pneumogastric  nerve. 


Fig.    146. — Relaxation   of  the   crico-thyroid. 

Mylo-hyoid  and  Hyoglossus. — The  mylo-hyoid  and 
hyoglossus  forming  the  floor  of  the  mouth  may  be  treated  as 
in  Fig.  145  .  When  the  maxillary  glands  are  congested,  it  is 
-necessary  to  relax  these  muscles.  The  physician's  right  hand 
•grasps  the  hyoid  bone,  being  careful  to  provide  enough  loose 
skin  above  the  bone  so  that  the  force  will  not  be  exerted  on 
the  cutaneous  tissues  instead  of  the  muscles  underneath.  After 


PRINCIPLES   OF  OSTEOPATHY. 


365 


the  hyoid  bone  is  pulled  downward,  the  tension  of  the  mylo- 
hyoid  is  increased  by  using  the  pressure  of  the  fingers  of  the 
left  hand. 


Fig.     147. — Reduction    of    subluxation    of    the    atlas — right    transverse    process    too 
far   posterior — exaggeration. 

Sterno-thyroid  and  Sterno-hyoid. — The  depressor  mus- 
cles of  the  larynx  and  hyoid  may  be  stretched  by  forcing  these 
structures  toward  the  angle  of  the  jaw,  while  the  free  hand 
makes  direct  manipulation  of  the  muscles.  In  all  cases  of  con- 
gestion of  the  glands,  mucous  membranes  or  cellular  tissues 


366 


PEINCIPLES   OF   OSTEOPATHY. 


Fig.     148. — Reduction    of    subluxation    of    the    atlas — lateral    flexion. 

of  the  mouth,  pharynx  or  larynx,  these  muscles  should  be  re- 
laxed if  the  position  of  the  atlas  has  been  corrected. 

Intrinsic  Muscles  of  the  Larnyx. — The  intrinsic  mus- 
cles of  the  larynx  sometimes  need  attention.     The  crico-  thyroid 


PRINCIPLES   OF  OSTEOPATHY. 


367 


is  the  tuning  muscle  of  the  larynx.     This  may  be  demonstrated 
by  grasping  the  thyroid  cartilage  with  the  thumb  and  fore- 


Fig'.    149. — Reduction   of   subluxation     of  the  atlas — extension  and  counter  pressure. 

finger  of  one  hand,  while  the  thumb  and  forefinger  of  the  other 
hand  grasps  lightly  the  cricoid  cartilage,  as  in  Fig.  146.  If 
the  cartilages  are  slightly  separated  while  the  patient  makes  a 


368 


PRINCIPLES  OF  OSTEOPATHY. 


vowel  sound,  the  pitch  of  the  voice  will  be  perceptibly  lowered. 
This  is  occasioned  by  relaxation  of  the  vocal  cords  by  separat- 
ing the  cartilages  which  stretch  the  crico-thyroid.  This  mus- 
cle is  innervated  by  the  external  branch  of  the  superior  laryn- 
geal  branch  of  the  pneumogastric.  The  motor  fibres  of  the 
superior  laryngeal  come  from  the  spinal  accessory,  hence  we 
find  lesions  in  the  cervical  articulations  which  are  primary 
causes  of  laryngeal  disorders. 


Fig.    150. — Manner  of  holding  the  head  and  neck  in  order  to  reduce  a  subluxated 
sixth  cervical  vertebra. 


The  Atlas. — The  atlas,  on  account  of  its  position,  free- 
dom of  movement,  numerous  muscular  attachments,  etc.,  is 
subject  to  frequent  subluxation.  Fig.  31  in  Chapter  VIII 
shows  the  normal  relations  of  the  mastoid  process,  transverse 
process  of  the  atlas,  and  the  angle  of  the  jaw.  Fig.  32,  in 
Chapter  VIII  shows  the  abnormal  relations  of  these  various 
prominent  points  as  they  are  frequently  found  by  the  osteo- 
path. When  the  right  transverse  process  is  near  the  mastoid, 
the  left  is  too  close  to  the  angle  of  the  jaw,  and  vice  versa. 

In  reducing  this  twist  of  the  atlas,  the  physician  should 


PRINCIPLES  OF  OSTEOPATHY.  369 

work  on  the  side  which  shows  the  transverse  process  to  be  pos- 
terior. The  same  principle  is  applied  in  reducing  this  subluxa- 
tion  as  was  described  in  connection  with  the  dorsal  lateral  sub- 
luxations.  Fig.  147  illustrates  "exaggeration."  Fig.  148 
shows  lateral  flexion  to  the  left,  while  the  physician's  fingers 
make  firm  pressure  back  of  the  prominent  transverse  process, 
thus  steadily  taking  advantage  of  all  the  relaxation  gained  in 
each  portion  of  the  movement.  The  termination  of  the  move- 
ment is  illustrated  in  Fig.  149.  Sometimes  the  atlas  slips  into 
place  with  an  audible  "click,"  but  more  often  the  physician 
feels  a  "gritting"  sensation  as  the  articular  surfaces  rub  over 
each  other.  When  the  subluxation  of  the  atlas  is  reduced  by 
this  movement,  it  will  hold  its  true  position  more  firmly  than 
will  any  other  vertebral  articulation  which  has  been  affected 
in  a  like  manner.  This  is  because  the  condyles  of  the  occiput 
fit  more  deeply  into  the  superior  articulating  surfaces  of  the 
atlas  then  is  the  case  between  articulating  surfaces  of  pairs  of 
vertebrae. 

Sixth  Cervical. — The  sixth  cervical  vertebra  is  espec- 
ially difficult  to  treat.  When  the  cervical  muscles  are  well 
developed,  it  is  obscured  to  the  touch  posteriorly,  but  the  caro- 
tid tubercles  anteriorly  can  be  felt.  It  is  not  wise  to  exert  much 
pressure  upon  bony  structures  from  the  anterior  surface  of 
the  neck.  There  are  so  many  glands,  nerves,  arteries,  etc., 
lying  over  the  transverse  processes,  that  direct  pressure  is  liable 
to  injure  them. 

Fig.  150  illustrates  a  method  of  reducing  a  subluxation  of 
the  sixth  cervical  vertebra.  The  patient's  chin  rests  in  the 
physician's  hands,  which  are  placed  on  each  side  of  the  neck 
and  near  enough  to  the  chin  to  support  it  by  the  little  finger. 
The  thumbs  are  used  to  affect  the  spine  directly.  The  com- 
pression of  the  head  and  neck  above  the  lesion  by  both  hands 
keeps  them  rigid  and  all  are  moved  together,  first  to  exaggerate 
the  lesion  of  the  sixth,  then  anterior  flexion  is  forced  in  the 
articulation  affected,  then  lateral  flexion  with  counter  pressure 
by  the  thumb  on  the  prominent  side  of  the  spine. 

This  movement  can  be  applied  to  subluxations  of  the  first 
and  second  dorsal. 


3?o  PRINCIPLES  OF  OSTEOPATHY. 


CHAPTER  XX. 


EXTREMITIES. 

Treatment  of  the  shoulder  for  synovial  adhesions,  liga- 
mentous  or  muscular  contractions  consists  of  movements  made 
in  the  normal  direction,  but  carried  farther  than  the  patient  can 
do  so  voluntarily. 

Diagnosis. — Test  the  extent  of  the  movements  normal 
to  the  articulation  to  ascertain  whether  the  loss  of  movement 
is  general  in  all  directions  or  results  from  impairment  of  some 
special  muscle  or  ligament. 

Causes  of  Stiff  Joints. —  The  history  of  the  case  will  us- 
ually give  an  insight  into  its  cause,  progress,  etc.  The  shoul- 
der articulation  is  frequently  stiffened  by  a  sprain,  dislocation, 
muscular  and  articular  rheumatism.  The  simplest  cases  are 
those  resulting  from  rest,  necessitated  by  a  broken  clavicle  or 
humerus. 

The  necessary  rest  after  a  dislocation  gives  the  strained 
ligaments  an  opportunity  to  shorten  and  thicken.  Movements 
should  be  frequently  forced  in  such  cases  to  prevent  any  syno- 
vial adhesions.  The  differentiation  of  cases  of  ankylosis  is  an 
important  one.  It  is  disheartening  to  physician  and  patient 
alike  to  find  that  after  weeks  of  earnest  effort  no  satisfactory 
results  are  obtained. 

An  article  on  "Ankylosis"  by  J.  S.  White,  D.  O.,  of  Pasa- 
dena, Cal,  published  in  Vol.  V.,  No.  IV.,  of  The  Osteopath, 
page  211,  deserves  quotation  here  because  it  notes  so  clearly  the 
important  points  which  the  student  ought  to  know.  With  his 
permission  it  is  quoted  in  full. 

"Ankylosis. — When,  from  an  injury,  disease  or  other 
cause,  a  joint  loses  its  function  and  becomes  stiff,  it  is  said  to 
be  ankylosed.  This  condition  may  be  termed  bony  (complete) 
or  fibrous  (incomplete),  true  (intra-articular)  or  false  (extra- 
articular)  ankylosis. 

"These  are  the  terms  used  by  Da  Costa  to  define  ankylosis, 
yet  some  claim  that  joint-stiffness  caused  by  extra-articular 


PRINCIPLES  OF  OSTEOPATHY.  371 

contraction  or  obstruction  is  not  ankylosis  in  the  correct  sense ; 
but  on  looking  at  the  derivation  of  the  word  (an(g)kulos — 
crooked  or  bent),  it  seems  that  the  term  ankylosis  would  be 
correct  when  applied  to  any  form  of  restricted  joint  move- 
ment." 

"The  causes  of  ankylosis  are  many.  First,  let  us  con- 
sider those  which  result  in  complete  and  incomplete  ankylosis. 
Inflammations  in  or  around  the  joint  from  whatever  cause,  if 
continued  long-  enough  for  new  tissue  formation,  will  cause 
ankylosis.  After  aseptic  inflammations  we  will  most  likely 
find  fibrous,  but  when  there  is  infection,  bony  ankylosis  is  more 
probable." 

"This  fibrous  formation  is  the  result  of  inflammation,  for 
wherever  there  is  inflammation  there  is  an  increase  of  tissue. 
Suppose  a  case  of  dislocation,  with  considerable  contusion  of 
the  tissues  around  the  joint,  inflammation  results,  and  embry- 
onic tissue  begins  to  form  as  a  reparative  process ;  the  embry- 
onic tissue  sends  out  small  processes,  which  start  from  new 
centers  and  spread  through  the  gelatinous  mass,  in  and  around 
the  joint,  until  a  very  irregular  network  is  spread  all  around 
the  joint  surface,  when  the  contraction  process  begins,  the  new 
tissue  is  formed  into  fibrous  tissue,  which  unites  the  bones 
closely  together;  by  cicatricial  contraction  the  bones  may  be 
drawn  so  closely  together  that  movement  is  almost  impossible." 

"Bony  union  of  the  joint  surface  follows  fibrous  anky- 
losis ;  it  occurs  when  the  borie  itself  is  injured  or  diseased,  and 
the  surface  of  the  bone  eroded  or  broken.  Ossification  begins 
chiefly  in  those  layers  of  fibrous  tissue  lying  next  to  the  bone." 

"False  or  extra-articular  ankylosis  is  caused  by  the  con- 
traction of  tissues  around  the  joint.  These  contractions,  exter- 
nal to  the  joint,  may  be  the  result  of  many  remote  and  obscure 
causes." 

"First.  Chronic  contraction,  which  may  be  due  to  dis- 
ease or  obstruction  to  the  nerve,  at  the  center,  or  in  its  course 
to  the  muscles.  As  the  normal  action  of  muscles  is  dependent 
on  normal  nerve  stimulus,  a  muscle  may  be  affected  in  various 
ways  by  the  stimulus  of  an  over-irritated  or  inhibited  nerve; 
excess  of  nerve  stimulation  will  cause  a  pathological  contrac- 


372  PRINCIPLES  OF  OSTEOPATHY. 

tion,  or  there  may  be  suspension  of  nerve  stimulus  and  paraly- 
sis of  muscles,  allowing  the  opposing  muscles  to  pull  and  hold 
the  joint  in  a  fixed  position." 

"Second.  Contractions  sufficient  to  cause  permanent  fixa- 
tions may  follow  the  healing  of  wounds,  ulcers  or  abscesses. 
Active  contraction,  from  any  cause,  if  kept  in  that  state  any 
length  of  time  can  cause  the  muscle  to  undergo  a  state  of 
fibroid  degeneration ;  tissue  waste  is  replaced  by  fat  and  fibrous 
material.  There  is  good  evidence  that,  after  a  time,  tissues 
which  have  not  fulfilled  their  function  lose  the  ability  to  do  so, 
and  the  nutritive  changes  accompanying  vital  activity  do  not 
take  place ;  the  contiguous  fibres  and  cells  become  adherent, 
agglutinated,  and  united  by  exuded  serum  and  waste  material 
not  carried  away  by  the  circulation,  sluggish  through  inactivity 
of  the  muscles." 

"The  tendons  and  ligaments  around  the  joint  are  thickened 
and  hardened  to  the  length  the  limb  was  held  by  the  active  con- 
traction, but  after  the  manner  of  all  newly  formed  tissue  it  con- 
tinues to  retract  and  draw  the  limb  more  out  of  its  normal 
position." 

"Third.  Contractions  may  be  the  result  of  certain  dis- 
eases (  as  rheumatism,  gout,  tuberculosis,  syphillis  or  any  dis- 
ease causing  non-use  of  the  joint  or  mal-nutrition  of  the  con- 
trolling muscles." 

"In  examining  an  ankylosed  joint,  we  must  distinguish 
between  bony  and  fibrous  ankylosis  and  extra-articular  contrac- 
tion. A  joint  may  be  immovable,  and  yet  not  so  because  of 
bony  ankylosis." 

"Da  Costa  says  that  a  joint  immovable  from  fibrous  anky- 
losis is  distinguished  from  a  joint  immovable  from  bony  anky- 
losis by  the  fact  that  in  the  former,  attempts  at  motion  are 
productive  of  pain  and  subsequently  of  inflammation;  there- 
fore, pain  on  attempted  motion  excludes  bony  ankylosis  from 
our  diagnosis.  An  approximate  idea  of  the  extent  of  the  stiff- 
ness may  be  obtained  from  a  history  of  the  case  as  to  whether 
the  disease  has  been  severe  in  character  and  long  in  duration. 
The  nerves  of  the  joint  should  be  examined  at  their  point  of 
exit  from  the  spine  and  throughout  their  course  to  the  joint." 


PEINCIPLES  OF  OSTEOPATHY.  373 

"The  same  conditions,  in  general,  which  cause  pain  in  a 
joint  may  cause  ankylosis,  whether  that  pain  be  due  to  local 
injury  or  referred  from  some  other  part — a  contracted  psoas 
muscle  by  irritation  to  the  branches  of  the  obturator  nerve  can 
cause  pain,  contraction  and  consequent  stiffness  of  the  knee 
joint." 

"What  can  osteopathy  do  for  this  condition?  For  bony 
ankylosis  nothing  should  be  attempted,  for  the  treatment  would 
only  result  in  discouragement  and  disappointment  to  both  phy- 
sician and  patient ;  but  if  the  joint  is  in  an  almost  useless  posi- 
tion, excision  or  osteotomy  may  be  tried  with  good  results.  If 
the  joint  has  become  ankylosed  through  septic  inflammation,  it 
should  not  be  forcibly  broken  up,  because  of  the  danger  of 
re-infection  of  the  whole  joint  or  other  parts  of  the  body 
through  the  circulation." 

"In  cases  of  fibrous  and  extra-articular  ankylosis  osteo- 
pathy can  refer  to  the  most  encouraging  records,  and  is  un- 
doubtedly ahead  of  any  other  method  of  treatment.  The  main 
point  in  the  treatment  consists  principally  in  making  active  the 
retarded  circulation,  gradually  breaking  up  the  adhesions,  thor- 
oughly relaxing  all  the  muscles,  and  a  stimulating  treatment 
to  the  nerves." 

"For  extra-articular  ankylosis  the  treatment  is  varied  ac- 
cording to  the  cause.  Osteopathy  has  a  great  mission  to  fill 
in  finding  and  removing  the  primary  cause  of  many  cases  of 
ankylosis.  Hilton  speaks  of  a  case  of  diseased  (tubercular) 
knee  joint  cured  by  ankylosis.  True!  the  rest  and  ankylosis 
was  nature's  way  of  reducing  the  inflammation  and  disease 
when  it  had  progressed  so  far.  But  the  work  of  the  osteopath 
is  to  look  for  the  causes  which  made  the  knee  joint  "a  point  of 
least  resistance"  for  the  tubercle  bacilli  to  multiply  in.  Exam- 
ine the  spine  thoroughly,  the  sacro-iliac  articulation  and  the 
hip  for  dislocations,  which  cause  pain  in  the  knee  joint  through 
irritation  of  the  obturator  nerve.  But  does  pain  alone  in  the 
joints  lead  to  the  condition  known  as  "a  point  of  least  resist- 
ance?" Pain  prevents  much  movement  in  the  joint,  and  re- 
membering that  continued  non-use  of  muscles  causes  mal- 
nutrition, sluggish  circulation,  and  degeneration  of  the  mus- 


374  PRINCIPLES  OF   OSTEOPATHY. 

cle,  we  may  see  how  the  joint  may  become  a  place  for  germs 
to  multiply." 

"Is  it  too  long  a  course  from  simple  pain  to  disease? 
Remember  that  pain  is  usually  accompanied  by  contraction  of 
muscle.  Our  treatment  must  be  both  preventive  and  cura- 
tive." 

"Following  is  a  case  of  fibrous  ankylosis  and  paralysis 
illustrating  the  efficiency  of  osteopathy  to  treat  this  class  of 
sufferers :  Vincent  Pete,  five  years  of  age,  had  an  ankylosed 
elbow  as  a  result  of  a  dislocation  and  break.  The  joint  was 
attended  to  immediately  after  the  accident  by  a  regular  physi- 
cian, but  was  kept  in  the  splints  too  long,  which  caused  the 
fibrous  ankylosis.  The  humerus  was  broken  just  above  the 
condyles,  and  a  small  spicula  of  bone  had  protruded  so  that  it 
interfered  with  those  fibres  of  the  median  nerve  which  supply 
the  flexor  muscles  of  the  thumb  and  forefinger  to  such  a  degree 
that  the  thumb  and  forefinger  were  completely  paralyzed  as  far 
as  the  flexor  movements  were  concerned.  The  forearm  was 
ankylosed  almost  at  a  right  angle  with  the  arm,  and  a  very 
little  movement  could  be  made,  and  that  with  great  pain;  the 
muscles  in  the  cervical  region  of  the  spine  were  sore  and  con- 
tracted. This  was  the  condition  of  the  patient  when  he  came 
for  treatment  eight  weeks  after  the  accident.  The  improve- 
ment began  with  the  first  treatment,  and  in  one  month  the  arm 
was  perfectly  straight  and  movable  in  any  direction,  and  he 
began  to  have  power  of  movement  in  his  finger  and  thumb; 
at  the  end  of  two  months'  treatment  his  arm  had  returned  to 
almost  its  usual  strength  and  flexibility.  I  saw  him  a  month 
later  and  the  arm  and  hand  were  perfectly  normal.  Contrast 
this  case  with  one  treated  by  mechanical  rest,  resulting  in  a 
fixed  elbow  joint,  or  perhaps  a  moderately  useful  joint  follow- 
ing forcible  breaking  of  adhesion  under  anaesthesia,  which  is 
a  dangerous  treatment,  with  very  doubtful  results,  as  the  oper- 
ation may  have  to  be  done  over  and  over  again  before  a  useful 
joint  is  gained." 

The  Scapulo-humeral  Articulation. — Fig.  151  illus- 
trates a  method  of  prying  the  head  of  the  humerus  out  of  the 
glenoid  fossa,  i.  e.,  separating  the  articular  surfaces.  This 


PRINCIPLES   OF  OSTEOPATHY. 


375 


movement  can  be  used  in  cases  of  muscular  rheumatism  when 
complete  abduction  of  the  arm  is  impossible.  It  also  allows 
an  influx  of  fresh  arterial  blood. 

When  abducting  the  arm,  the  scapula  must  be  held  by 
the  physician's  hands.  Place  the  fingers  on  the  vertebral  bor- 
der of  the  scapula  while  the  axillary  border  is  compressed  by 


Fig.     151. — Manner    of 


applying    leverage    to    stretch    the    structures    forming    the 
scapulo-humeral   articulation. 


the  thumb.  By  holding  the  scapula  securely,  the  physician  is 
sure  that  all  the  movement  he  forces  is  in  the  shoulder  articula- 
tion, and  not  the  gliding  of  the  scapula  on  the  thorax.  The 
muscles  of  the  arm  may  be  relaxed  by  direct  manipulation. 
The  insertion  of  the  deltoid  is  frequently  tender.  Any  wasting 
of  the  muscles  of  the  extremity  should  be  carefully  noted,  so 
that  the  course  of  its  governing  nerve  may  be  searched  for  a 
point  of  compression. 


376  PEINCIPLES  OF  OSTEOPATHY. 

Examination  of  the  Brachial  Plexus. — The  principal 
motor  divisions  of  the  brachial  plexus  may  be  tested  by  simple 
movements  made  by  the  patient.  The  patient's  gripping  power 
is  an  index  to  the  condition  of  the  median  nerve,  and  the  mus- 
cles it  innervates.  Extension  of  the  forearm,  wrist  and  fingers 
made  against  resistance  is  an  index  of  power  in  the  musculo- 
spiral  nerve  tract.  Abduction  and  adduction  of  the  fingers  are 
controlled  by  the  ulnar  nerve.  Flexion  of  the  forearm  by  the 
musculo-cutaneous. 

Observe  the  condition  of  the  first  posterior  interosseous 
muscle  which  forms  the  little  muscular  swelling  when  the 
thumb  is  adducted  to  the  second  metacarpal  bone.  If  it  is 
wasted -there  is  evidence  of  nerve  cell  degeneration.  This  mus- 
cle should  be  well  developed  in  thin  hands  as  well  as  in  fat 
ones.  If  the  wasting  is  uni-lateral,  look  for  impingement  on 
the  ulnar  nerve  at  some  point  in  its  course.  If  it  is  bilateral 
the  cells  in  the  spinal  cord  are  probably  at  fault. 

The  deltoid  is  frequently  painful  as  a  result  of  pressure  on 
the  circumflex  nerve.  The  pressure  is  usually  at  the  point  of 
exit  from  the  vertebral  canal.  Relaxation  of  the  structures 
around  its  point  of  exit  usually  relieves. 

Reduction  of  Dislocations  by  Traction. — The  general 
method  applied  to  dislocations  of  all  joints  of  the  extremities 
is  direct  traction.  This  is  sometimes  aided  by  pressure  on  the 
prominent  point  of  the  dislocated  bone  to  aid  it  in  slipping  to 
its  place.  All  of  the  dislocations  of  the  humerus,  subcoracoid, 
subclavicular,  subglenoid  and  subspinous,  can  be  reduced  by 
using  traction  to  stretch  the  muscles  and  ligaments  of  the  joint 
to  the  extent  that  the  head  of  the  humerus  will  slip  over  the 
rim  of  the  glenoid  fossa.  This  traction  may  be  made  with  the 
patient  sitting,  as  in  Fig.  142.  The  knee  in  the  axilla  springs 
the  head  of  the  humerus  outward.  The  same  treatment  may 
be  applied  with  the  patient  reclining.  The  physician  should 
place  a  ball  of  woolen  yarn  in  the  axilla,  then  place  his  stock- 
inged foot  upon  it,  and  make  traction  on  the  arm. 

It  is  possible  to  apply  the  traction  method  in  a  simpler 
way.  An  ordinary  canvas  cot,  with  a  hole  cut  in  it,  so  that 
the  arm  can  be  put  through  while  the  patient  rests  easily  on  his 


PRINCIPLES   OF   OSTEOPATHY. 


377 


Fig.    152. — A    position    for    easy   manipulation    of    the    scapulo-humeral    articulation. 

side,  should  be  elevated  far  enough  from  the  floor  to  allow  a 
six-pound  weight  to  be  attached  to  the  wrist.  This  steady 
weight  quickly  relaxes  the  muscles  and  reduces  the  subluxa- 
tion. 

Traction  always  strains  the  muscles  and  causes  some  heat 


378  PRINCIPLES  OF  OSTEOPATHY. 

and  swelling,  therefore,  care  should  be  taken  to  prevent  exud- 
ates  and  adhesions. 

Reduction  of  Dislocations  by  Leverage.— Those  who 
are  expert  in  reducing  shoulder  dislocations  usually  make  use  of 
a  series  of  movements  which  exaggerate  the  lesion,  i.  e.,  make 
the  head  of  the  dislocated  bone  more  prominent.  In  subcora- 
coid  dislocations  of  the  humerus,  abduction  of  the  arm  causes 
exaggeration.  The  physician  stands  at  the  side  of  the  patient, 
who  is  reclining  on  a  hard  surface.  As  abduction  is  made,  the 
physician's  free  hand  rests  upon  the  head  of  the  humerus. 
From  the  position  of  abduction  the  arm  is  carried  inward  and 
forward  on  a  level  with  the  shoulder,  at  the  same  time  being 
rotated  internally  so  that  the  external  condyle  will  be  in  front 
of  the  patient's  nose,  then  carry  the  arm  downward  to  the 
side  with  a  quick,  vigorous  movement,  at  the  same  time  exert- 
ing pressure  on  the  head  of  the  bone  as  before  mentioned. 
This  series  of  movements  must  be  made  quickly,  and  the  pres- 
sure on  the  head  of  the  bone  be  most  intense  while  the  internal 
rotation  and  adduction  are  at  the  maximum. 

This  series  of  movements  may  be  employed  to  break  up 
synovial  adhesions. 

Elbow  Dislocations. — Elbow  dislocations  are  infre- 
quent compared  to  those  of  ball  and  socket  joints.  The  possible 
dislocations  of  the  ulna  are  lateral  and  posterior.  The  former 
require  traction,  the  latter  is  reduced  by  placing  the  bend  of 
the  patient's  elbow  over  the  physician's  knee.  Traction  with 
one  hand  on  the  patient's  wrist  while  the  other  hand  makes 
pressure  on  the  olecranon  will  force  the  ulna  into  place.  This 
dislocation  is  usually  complicated  with  fracture  of  the  coronoid 
process. 

The  Radius. — The  radius  may  be  dislocated  posteriorly 
or  anteriorly.  Lateral  dislocations  of  either  radius  or  ulna 
carry  both  bones  together.  A  posterior  dislocation  of  the 
radius  can  be  reduced  by  flexion  of  the  forearm,  then  extension 
with  counter  pressure  on  the  prominent  point  of  the  head  of 
the  radius  posteriorly.  A  forward  dislocation  requires  supin- 
ation  of  the  arm  and  adduction  of  the  hand,  together  with  pres- 
sure on  the  anterior  surface  of  the  head  of  the  radius. 


PKINC1PLES  OF  OSTEOPATHY. 


379 


Dislocations  of  the  bones  of  the  wrist  or  hand  are  reduced 
by  traction  or  pressure. 

Old  Dislocations. — All  dislocations  twenty-four  hours 
old  require  considerable  relaxing  treatment.  The  older  they 
are,  the  harder  they  are  to  reduce.  Nature  begins  to  adapt 
herself  to  new  conditions  almost  immediately.  All  the  slack 
of  muscles  and  ligaments  is  swiftly  taken  up.  Those  tissues 
most  compressed  by  the  new  position  of  the  bone  are  impover- 


Fig-    i S3- — Relaxation   of   the   quadriceps   extensor. 

ished  by  the  lack  of  nourishment.  Thickenings  and  adhesions 
quickly  form,  so  that  old  dislocations  are  not  easily  handled. 
Old  dislocations  are  treated  in  the  same  manner  as  fresh  ones, 
except  that  much  relaxing  and  restoring  of  vitality  is  neces- 
sary. 

Muscles  of  the  Lower  Extremity. —  The  muscles  of  the 
lower  extremity  may  be  relaxed  either  by  direct  manipulation 
or  by  taking  advantage  of  the  movement  of  various  joints  to 
put  them  on  a  stretch.  Direct  manipulation  is  laborious  and 
requires  considerable  time. 


380  PEINCIPLES  OF  OSTEOPATHY. 

The  muscles  of  the  hip  joint  frequently  contract  sufficiently 
to  make  walking  difficult.  They  contract  as  a  result  of  strain, 
bruise,  disease  of  the  joint,  subluxation  of  lumbar  vertebrae, 
or  luxation  of  the  iliac  bones.  The  subluxations  irritate  the 
nerves  which  innervate  the  muscles  controlling  the  joint. 

The  movements  hereafter  outlined  may  be  used  for  many 
different  purposes,  but  they  are  applied  here  to  specific  groups 
of  muscles.  All  the  movements  we  have  thus  far  outlined  have 
been  described  according  to  the  way  they  affect  structure,  not 
function. 


Fig.    154. — Relaxation    of    the    quadriceps    extensor — sacro-vertebral    articulation    al- 
lowed to  remain  moveable. 

the  thigh  is  innervated  by  the  anterior  crural  nerve.  In  order 
Quadriceps  Extensor. — The  quadriceps  extensor  of 
to  stretch  this  muscle  the  patient  should  lie  face  downward. 
The  physician  grasps  the  patient's  ankle  with  the  left  hand 
as  in  Fig.  153.  The  right  hand  holds  the  pelvis  to  the  tabte. 
Lifting  with  the  left  hand  puts  the  muscle  on  a  tension  which 
can  be  easily  increased  by  flexing  the  knee. 

This  movement  stretches  the  fascia  over  Poupart's  liga- 
ment and  the  saphenous  opening. 


PRINCIPLES   OF  OSTEOPATHY.  381 

Fig.  154  illustrates  a  similar  movement  to  the  preceeding, 
but  it  is  not  so  powerful.  When  the  patient  lies  on  the  side,  his 
back  bends  to  the  force  of  the  movement  of  the  leg.  If  the  phy- 
sician grips  the  ankle  instead  of  the  knee  there  is  a  great  in- 
crease in  the  effect  of  the  movement. 

The  Adductor  Group. — The  adductor  group  of  thigh 
muscles  innervated  by  the  obturator  nerve,  can  be  stretched 
as  in  Fig.  155.  If  there  is  any  inflammation  in  the  acetabulum, 


F>£-    155- — Relaxation   of  the  adductor  muscles   of  the   thigh. 

this  movement  will  cause  the  patient  great  distress,  because  it 
stretches  the  teres  ligament. 

Dislocation  of  the  Femur. — Dislocations  of  the  hip 
joint  are  usually  caused  by  the  forcible  spreading  of  the  legs. 
The  head  of  the  femur  is  thus  forced  over  the  edge  of  the 
acetabulum  at  its  dependent  and  weakest  part,  the  cotyloid 
notch.  It  passes  into  the  thyroid  foramen,  and  if  it  remains 
there  all  the  muscles  are  stretched  very  tight,  and  no  voluntary 
movement  is  possible.  The  direction  the  head  takes  is  depend- 
ent on  the  direction  of  the  force.  If  the  knee  points  anteriorly 
at  the  time  of  the  forced  extreme  abduction,  the  head  after 


382 


PRINCIPLES   OF   OSTEOPATHY. 


entering  the  thyroid  foramen  passes  out  of  it  posteriorly  and 
takes  a  position  over  the  spine  of  the  ischium,  great  sciatic 
foramen  or  outer  surface  of  the  ilium,  all  owing  to  the  vigor- 
ous pulling  of  the  muscles.  If  the  knee  points  posteriorly, 
the  head  of  the  femur  travels  to  a  position  under  the  anterior 
inferior  spine  of  the  ilium. 

The  movements  made  to  reduce  these  subluxations  take 
into  consideration  the  fact  that  the  head  of  the  femur  must  be 
made  to  retrace  its  route  in  order  to  regain  its  proper  position. 


Fig.    156. — Method   of  stretching  the   sciatic    nerve. 

For  example,  a  dislocation  posteriorly  on  to  the  spine  of  the 
ischium  causes  the  toe  to  turn  inward,  and  there  is  slight 
shortening  of  the  leg.  The  physician  takes  a  position  as  in  Fig. 
157  and  carries  the  knee  upward  and  inward.  He  forces  the 
knee  as  far  as  possible  across  the  median  line,  then  flexes  the 
thigh  hard  on  the  abdomen.  This  turns  the  head  of  the  femur 
downward  and  inward.  Remember  that  the  head  points  always 
in  the  same  direction  as  the  internal  condyle.  Now  forcibly 
abduct  and  extend  the  thigh  with  a  quick  external  rotation. 
These  movements  cannot  be  made  successfully  without  a  long 


PKINCIPLES  OF  OSTEOPATHY. 


383 


course  of  preliminary  relaxing  treatments,  that  is,  if  the  dis- 
location is  an  old  one. 

Direct  traction  may  be  used  for  all  dislocations  of  the 
femur  just  as  for  the  shoulder,  but  the  muscles  are  so  strong 
that  it  is  no  small  matter  to  overcome  them,  hence  movements 
which  take  advantage  of  leverage  are  much  more  satisfactory. 

The  formula  for  any  dislocation  of  the  hip  may  be  worked 
out  by  noting  the  position  of  the  head  of  the  femur  and  then 
carrying  the  internal  condvle  so  as  to  make  the  head  retrace  its 


Fie.    IS7- — Relaxation    of   the    pyriformis. 

course.  When  shortening  or  lengthening  of  the  leg  is  noted, 
make  sure  that  the  iliac  bones  are  even.  A  half-inch  difference 
in  them  may  easily  be  accounted  for  by  the  action  of  the  hip 
muscles. 

The  pyriformis  muscle  may  contract  and  compress  the 
sciatic  nerve  in  its  course  through  the  great  sciatic  foramen. 
Fig.  157  illustrates  the  movement  to  stretch  the  pyriformis. 
The  physician  holds  the  pelvis  to  the  table  by  pressing  on  the 
anterior  superior  spine  of  the  ilium.  The  thigh  is  then  strongly 
adducted. 

Stretching  the  Sciatic  Nerve. — Sciatica  is  frequently 
successfully  treated  by  relaxing  the  pyriformis,  but  the  major- 


384  PRINCIPLES  OF  OSTEOPATHY. 

ity  of  cases  require  a  stretching  of  the  sciatic  nerve,  which  is 
performed  as  in  Fig.  157.  The  physician  has  great  leverage  in 
this  movement.  It  stretches  all  the  flexor  group  on  the  back 
of  the  thigh. 

The  Calf  Muscles. — The  calf  muscles  sometimes  con- 
tract and  make  it  difficult  for  the  patient  to  get  the  heel  to  the 
floor.  Fig.  158  illustrates  the  method  of  applying  leverage  to 
the  case. 


Fig.    158. — Method  of  stretching  the  deep   and   superficial   muscles  on  the 
back  of  the  leg. 

Scientific  Manipulation. — Every  group  of  muscles  in 
the  body  can  be  relaxed  by  stretching  them,  hence  if  the  student 
will  study  their  attachments  and  the  effects  of  their  normal 
contraction,  a  series  of  movements  can  be  devised  to  suit  the 
condition.  Learn  anatomy  in  a  practical  manner  and  a  system 
of  osteopathic  movements  will  spring  forth  from  the  under- 
standing mind  of  the  student.  The  author  has  tried  the  plan 
of  not  demonstrating  movements  to  students,  but  putting  the 
whole  attention  to  understanding  the  conditions  in  the  patient 
which  require  treatment.  A  study  of  the  mechanical  difficulties 
presented  and  the  comparison  of  these  with  the  normal  relations 
leads  the  student  to  apply  anatomical  knowledge  in  treatment. 
If  the  student  understands  the  case,  that  is,  realizes  the  signifi- 
cance of  the  points  found  by  the  physical  diagnosis  he  can  be 
depended  upon  to  apply  a  rational  method  of  treatment.  As 


PRINCIPLES  OF  OSTEOPATHY. 


385 


soon  as  the  student  makes  a  movement  in  a  certain  manner  in 
order  to  copy  his  instructor  instead  of  basing  it  on  his  own 
understanding  of  the  condition  treated,  he  degenerates  to  mere 
empirical  methods. 

Saphenous  Opening. — The  circulation  in  the  lower  ex- 
tremity is  frequently  affected  on  the  venous  side  by  tension  at 
the  saphenous  opening.  Enlargement  of  the  superficial  veins 
of  the  leg  above  a  point  three  or  four  inches  above  the  ankle 


Fig.  159. — Position  for  easy  manipulation  of  the  saphenous  opening. 

denotes  obstruction  to  free  blood  flow  in  the  long  saphenous 
vein.  Abduction  and  extension  of  the  thigh  will  stretch  the 
fascia  forming  the  saphenous  opening,  then  place  the  thigh 
in  a  semi-flexed  position,  as  in  Fig.  159,  to  facilitate  direct 
manipulation  of  the  tissues  forming  this  opening.  The  deep 
and  superfical  veins  of  the  leg  have  little  or  no  communication 
above  a  point  about  the  junction  of  the  lower  and  middle  third 
of  the  leg.  This  applies  especially  to  the  long  saphenous  vein. 
Varicose  veins  on  the  feet  or  ankles  may  be  drained  by  both 
superficial  and  deep  veins,  therefore,  their  existence  in  these 


386 


PEINCIPLES  OF  OSTEOPATHY. 


Fig.    1 60. — Position    for   easy   manipulation   of  the   popliteal   space. 

locations  may  be  due  to  visceral  causes,  even  when  there  is  no 
obstruction  to  the  saphenous  opening. 

Popliteal  Space. —  The  popliteal  space  sometimes  needs 
relaxation.  This  is  performed  by  direct  manipulation  as  illus- 
trated in  Fig.  160.  The  position  of  the  physician's  hands  in 
this  illustration  affect  the  upper  portion  of  the  popliteal  space. 
By  facing  the  patient  the  lower  portion  can  be  easily  affected. 


CHAPTER  XXI. 


MANIPULATION  FOR  VASO-MOTOR  NERVE 
EFFECTS. 

There  are  times  when  the  physician  desires  to  affect  the 
amount  of  blood  in  the  tissues  of  the  head.  There  may  be  a 
congestion  of  the  nasal,  pharyngeal  and  laryngeal  mucosa  as 
during  a  hard  "cold."  The  condition  has  come  on  as  a  result  of 
thermal  stimuli.  After  manipulating  to  relax  the  muscles  of 


PRINCIPLES   OF   OSTEOPATHY. 


387 


the  neck  and  overcome  any  effects  these  may  have  had  on  the 
position  of  the  cervical  vertebrae,  it  is  well  to  try  to  cause  vaso- 
constrictor action  by  stimulating  nerve  endings.  Fig.  161  illus- 
trates a  method  of  stimulating  deeply  under  the  zygoma  in  the 
sigmoid  notch  of  the  inferior  maxillary  bone.  When  the  pa- 
tient opens  his  mouth,  the  physician  places  his  ringer  over  the 


Fig.    161. — Stimulation   between   the  zygoma  and   the   sigmoid   notch  of  the 
inferior   maxilla. 

depression  below  the  zygoma  and  presses  inward,  at  the  same 
time,  making  a  vibratory  movement  of  the  finger.  This  affects 
the  branches  of  Meckel's  Ganglion  and  through  it  the  nasal 
mucosa.  It  is  a  painful  treatment,  but  the  blood  will  often 
surge  from  the  mucous  tissues  to  the  skin  as  a  result  of  it. 

About  the  same  effect  is  secured  by  using  the  movement 
illustrated  in  Fig.  162.  While  the  patient's  mouth  is  open,  the 
physician  places  his  thumbs  on  the  bridge  of  the  nose,  and  his 


388 


PRINCIPLES   OF   OSTEOPATHY. 


Fig.    162. — Stimulation    by    forcible    closure    of    the    mouth    against    resistance. 

fingers  at  the  angles  of  the  jaw.  The  tips  of  the  little  and  ring 
fingers  are  pressed  into  the  depression  caused  by  the  forward 
movement  of  the  condyle  of  the  jaw  on  the  eminentia  articu- 
laris.  The  physician  forces  the  mouth  shut  while  the  patient 
opposes.  The  position  of  the  tips  of  the  little  and  ring  ringers 
prevents  the  easy  slipping  of  the  condyles  into  the  glendoid 
fossa.  The  sensory  fibres  around  the  condyle  are  intensely 
stimulated  and  frequently  manifest  it  by  spreading  a  flood  of 
color  over  the  face  in  front  of  the  ear.  This  is  also  a  painful 
stimulation.  It  is  highly  probable  that  all  movements  of  this 
character  which  are  painful  secure  results  by  causing  activit) 
of  the  dilator  nerves  to  blood  vessels  in  superficial  tissues,  thus 
depleting  the  blood  in  the  congested  area.  A  sharp  pain  may 
cause  a  sudden  blanching,  but  it  is  followed  by  vaso-dilation. 


PRINCIPLES   OF  OSTEOPATHY. 


389 


If  it  is  difficult  for  the  patient  to  breathe  through  the  nos- 
trils, press  on  the  nasal  bones,  first  on  the  right  side,  then  left, 
then  make  a  heavy  pressure  over  the  junction  of  the  nasal  and 
frontal  bone  with  one  thumb  above  the  other.  This  movement 
is  very  pleasant  to  the  patient  ordinarily. 

To  carry  off  the  venous  blood,  make  a  stroke  from  the 


Fig.    163 — Points  of  exit  of  divisions  of  the  fifth  cranial  nerve. 

inner  canthus  of  the  eye  downward  over  the  junction  of  the 
masseter  muscle  with  the  lower  jaw,  thence  to  the  supra- 
clavicular  fossae. 

The  Fifth  Cranial  Nerve. —  The  fifth  cranial  nerve  can 
be  treated  at  its  points  of  exit  through  the  bones  of  the  face. 
Fig.  163  illustrates  the  position  of  these  points.  A  vibratory 
pressure  over  these  points  causes  a  dull  but  increasing  pain. 


39° 


PRINCIPLES  OF   OSTEOPATHY. 


If  the  movement  is  made  quickly  and  vigorously,  there  will  be 
evidence  of  a  reaction  in  a  flushed  appearance. 

Inhibition  of  Suboccipital. — When  there  is  a  high  blood 
pressure  in  the  head  and  the  patient  is  suffering  with  headache 
it  is  possible  to  give  great  relief  by  steadily  inhibiting  in  the 
suboccipital  fossae  and  temples,  as  illustrated  by  Fig.  164. 
All  nervous  conditions  are  greatly  reduced  by  this  movement. 


Fie.    164. — Inhibition    in    the    suboccipital    fossae. 

The  inhibition  reduces  the  number  of  sensory  impressions,  and 
lessens  the  tension  of  blood  vessels  all  over  the  body.  This 
inhibitory  movement  should  be  used  in  cases  of  epilepsy  and 
delirium  tremens  during  the  excitable  stages.  Have  an  assist- 
ant inhibit  in  the  splanchnic  area,  thus  causing  a  general  re- 
duction of  blood  pressure  in  the  superficial  and  deep  tissues  of 
the  body  and  extremities.  The  blood  is  thus  drawn  away  from 
the  head,  and  the  patient  becomes  quiet. 

To  inhibit  the  transmission  of  impulses  to  the  diaphragm 


PRINCIPLES  OF  OSTEOPATHY. 


391 


Fig.    165. — Inhibition    of    the    phrenic    nerves — center   for  hiccough. 

by  the  phrenic  nerves  pressure  should  be  made  as  in  Fig.  165. 
The  physician's  fingers  compress  the  phrenic  nerve  against  the 
scalenus  anticus. 

The  phrenic,  pudic  and  pneumogastric  are  the  only  nerve 


392 


PKINCIPLES  OF  OSTEOPATHY. 


Fig.    1 66. — Stimulation  of  the  pneumogastric   nerves. 

trunks  distributed  in  the  body  which  can  be  easily  compressed 
through  soft  tissue.  Fig.  166  illustrates  stimulation  of  the 
pneumogastric.  The  physician's  fingers  roll  over  the  nerve 
trunk  where  it  lies  along  the  inner  edge  of  the  sterno-cleido- 
mastoid. 


I  N" 


X 


A 

Page. 

Accommodation     34,  273 

Acceleration  of  the  heart.  . 

77,   120,  231,   278 

Attribute  of  nerve  tissue.  .  .279,  280 

Abdomen,   Examination   of 301 

Alignment     290 

Angina  pectoris   78,  228 

Anatomy     136 

Anaesthetic,  Inhibition  as  a  local  287 

Annulns  of  Vieussens 121 

Ankle,   The 136 

Ankylosis    370 

Articulation,   Occipito-atlantal. .  .167 

Costo-transverse    187 

Costo-central    187 

Dorso-lumbar     184 

Sacro-iliac      169,  192 

Sacrtf-vertebral     198 

Scapulo-humeral    374 

Arteries  — 

Vertebral    121 

Internal    Mammary 121 

Inferior    Thyroid 121 

Xervi  Comes    Phrenici 121 

Descending  Aorta    122 

Astringents     107 

Atrophy,    Secretory    cells 113 

Atlas   167,   175,  368 

Axis   l"."i 

Spontaneous  Reduction   of 176 


Blood  68 

Corpuscles,  Bed  69 

Corpuscles,  White  69 

Chemical  constituents  of 71 

Distribution  of  71 

Supply  107,  108 

Back,    Skin    of 89 


Page. 

Bacteria   33,  265 

Bladder  center 251,  253 

Brain,  Vaso-motor  center....   88,  92 
Brachial  Plexus    220,  222,  376 


Cause  and  Effect 30 

Capillary    circulation     86 

Cathartics     107 

Carotid  plexus 119 

Cardiac   plexus    128 

Caries    175 

Cauda    equina    251 

Cell,  Attributes  of  the   36 

Arrangement   in   glands 104 

Individuality    of    the 105 

Life  dependent  on  circulation.  .31 

Resistance    30 

Relations     30 

Stimuli    29 

Sexual     104 

Centers,  Vaso-motor 88,  281 

Abdominal    viscera    132 

Cilio-spinal     123 

Hyperaemia   of Ill 

Centers,   Osteopathic 211 

Bladder    251,   253 

Chills     245 

Cilio-spinal     228 

Defecation    251 

Gall  Bladder    246 

Heart   77,  79,  228 

Kidneys     250 

Intestines   241,  248,  215 

Liver  and  Spleen    240 

Lung    227 

Micturition     251 

Ovaries  and  Testes   250 

Parturition  _•'! 


INDEX. 


Page. 

Kectum    '..251 

Sphincter  Vaginae   254 

Stomach     233 

Uterus     248 

Cervical  Plexus    217 

Cervical  Vertebrae    177 

Extension     361 

Eegion     358 

Cilio-spinal   center    123,   228 

Circulatory    Tissue    67 

Functions      67 

Apparatus     72 

Chills     245 

Cholelithiasis    247 

Chorda   Tympani    109 

Clavicles    192,   358 

Compensation    34,   112,   275 

Constipation   31,   113 

Contraction,  Effects  of  muscular 

48,    279 

of  the  heart    74 

Conductivity      53 

Contraction,   Muscular    179 

Co-ordination     187 

of   sensation    65 

of  heart  centers   75 

of   circulation    71 

Coronary  arteries   78 

Costo-eentral    Articulation     187 

transverse     187 

Costal   Subluxations    188 

Cure,    Methods    of 34 

Curvature     329 

Compensatory    275 

D 
Definitions  of  Osteopathy. 

By  E.  K.  Booth,  Ph.D.,  D.  0 22 

By  C.  M.  Case,  M.  D.,  D.  0 21 

By  Charles  Hazzard,  Ph.B.,  D.  O..21 

By  J.  W.  Hof sess,  D.  0 23 

By  J.  Martin  Littlejohn,  LL.  D., 

M.  D.,  D.   0 21 

By  Mason  W.  Pressly,  LL.  D., 

M.  D.,  D.  0 20 


Page. 

By  Chas.  C.  Keid,  D.  0 24 

By  Wilfred  L.  Eiggs,  D.  0 24 

By  A.  T.  Still,  M.  D.,  D.  0 20 

By  C.  M.  Turner  Hulett,  D.  O....23 

By  Chas.  C.   Teall,  D.   0 22 

By  Dain  L.  Tasker,  D.  0 24 

By  C.  W.  Young,  D.  0 23 

Development  of  bones,  Unequal.  .175 

Defecation,    Center 251 

Depressed  Spine   337 

Diaphoretics     107 

Diagnosis,  Osteopathic 

24,  59,  61,  65,  213,  284 

Diarrhoea   31,  113,  276 

Diffusion    105 

Diphtheria    44,   269 

Disease,  Cause  of 19.  29,  33 

Germ    Theory    of 264 

Dislocations,    Atlas    168 

Eeduction   of    376,   378 

of  the  Femur 381 

eld    379 

Diuretics     107 

Dorsal  Vertebrae   178 

Botation     329 

Dorso-lumbar  Articulation   184 

Drugs   107,   113 


E 


Efferent  nerve  fibers 60 

Emmenagogues    107 

Energy,  Potential  and  Kenetic  ...  29 

Encysting,   The   power   of 277 

Epithelium     100 

Erector    Spinae     315 

Errhines     107 

Examination,    of   Abdomen 301 

Of  the  Neck    303 

Positions  for   290 

Of  Eectum  and  Prostate  Gland  303 

Expectorants     107 

Extension  in  the  Cervical  Ee- 
gion     361 


INDEX. 


Page. 
External      Generative        Organs 

Vaso-motor  Center 88 

Extremities,   The 276,  305,  370 

Eye,  Nutrition  of 119,   174 

Vaso-motor    Center    88 


Fascia    34 

Fatigue    34 

Fear     113 

Femur,   Dislocation   of 381 

Fever     112 

Filtration    105 

Flexibility    290 

Thoracic    300 

Food,    Secretion    108 

G 

Gall  Bladder  132 

Bladder,  Center  246 

Ganglia,  Cervical  118 

Gasserian  123 

Impar  115 

Lateral  115 

Lumbar  126 

Kibes  115,  119 

Sacral  127 

Samilunar  .  .  . .  : 131 

Thoracic  122 

Visceral,  Automatic 115,  134 

Germ  Theory  of  Disease 264 

Gland,  Arrangement  of  Cells..., 104 
Formation  103 

Gums,   Vaso-motor   Center 88 


Head,  Vaso-motor  Center 88 

Head's   Law    142 

Headache    119 

Heart    72,   74 

Accelerator  center 77,  120 

Action   of   heart    centers 79 


Page. 

Center   75,  228,  231 

Compensation     277 

Coronary  arteries    78 

Effect   of  Vaso-motor   nerves.. Ill 

Inhibition  of  the  heart 78,  120 

Pneumogastric    nerve    75 

Regulation    of    contraction 74 

Reflexly   affected    248 

Stimulation    of   the 77 

Heat     113 

Hemiparesis     222 

Hemiplegia     96 

Heredity   31 

Herpes  Zoster    141 

Hiccough     219 

Hilton's  Law 135,  214,  281 

Human  body,  Conception  of 285 

Hyperaemia    90,   111 

Hyperaesthesia,  Diagnostic  value 

of    284,   298 

Of  sensory  areas 284 

Hyperplasia     93 

Hypogastric  Plexus   333 

Hyo-glossus    muscle     364 

Hyoid  bone    363 


Inco-ordination    188 

Inferior  Cervical  Ganglion 120 

Inflammation      102 

Inhibition    31,   278 

As  attribute  of  nerve  tissue... 280 

As  Local  Anaesthetic 287 

As    Preparatory    treatment.  ..  .289 

In    Sub-occipital    Fossae 390 

Osteopathie   Meaning   of 286 

Of   Intestinal   Secretion 113 

Of  the   Heart    78 

Of     Vaso-constriction 96 

Pneumogastric  nerve 76,   120 

Results  of   248 

Scientific   use   of 286 

Therapeutic    281 

To  Remove  Lesions.  .  .-_'** 


INDEX. 


Page. 

Immunity     266 

Innominate  Bones,  Luxation  of 

192,    352 

Inspection    292 

Internal  Generative  Organs    89 

Interseapular   Kegion    

112,  123,  130,  225 

Intestines,   Center    132 

Large     241 

Small    242,   248 

Vaso-motor  Center 88 

Irritability     52 

Ischaemia  .  .90 


Joints,  Formation  of 166 

Cause  of  Stiff  .  .  .370 


Katabolism    102 

Kidneys,   Compensation    276 

Vaso-motor  Center   ...89,  126,  250 

Knee,   The    136 

Kyphosis,  Lower  dorsal 185,  339 

Upper  dorsal   322 

Lumbar    185,   251,   325 

Treatment  of 316,  299 


La   Grippe    113 

Language  of  pain    246 

Larynx,  Intrinsic  muscles  of.... 366 

Lateral    curvature    329 

Subluxations    179,  183,  331 

Latissimus  dorsi   308 

Law,  Hilton 's    135,   281 

Head's    142 

Lesions,    Definition 144 

Cause    of    161 

Classes    of    161 

Correction  of   164 

Diagnosis   of    16.3 

Effect    of    44,    49 


Page. 

False    163,    178 

History   of    145,   305 

Primary  and  secondary.  .  .  .42,  166 

Remove    285,   288 

Leukemia     237 

Life,  Conditions  which  affect  it. 265 

Liver,   Vaso-motor    center 

89,  132,  240 

Locomotor   ataxia    63 

Lordosis,    Upper    dorsal 318 

Lumbar  Eegion   31,  185 

Ganglia    126 

Kyphosis     185 

Plexus     253 

Lung   Center    88,   227 

Lymph     67 

M 

Manipulation    110,  306 

Abnormal   Sounds     200 

Methods    307 

Normal  Sounds   199 

Pathology     of     Joints     Pro- 
ducing  Abnormal    Sounds. 200 

Scientific     384 

Massage    l]Q 

Metabolism     100 

Micturition,  Center    251 

Middle  Cervical  ganglion    120 

Movements,   Passive   vs.   Rest... 289 

Mucus    104 

Muscular  contraction 159,  179 

Tension,  Test 300 

Muscle.  Circulation   in    48 

Contraction  of    45,  279 

Development    of 10] 

Nerve  distribution  to 137 

Stimuli    of    43 

Vaso-motor  center    89 

Muscles,  Adductors  of  the  thigh. 381 

Cireulation   of  Blood  in 47 

Deltoid    140 

Erector   spinae    315 

Hyo-glossus    364 


INDEX. 


Page. 

Latissimus  dorsi   308 

Mylo-hyoid    364 

Of  the  Back,  Extrinsic  and  in- 
trinsic     295 

Of  the  Larynx,  Intrinsic 366 

Of  the  Leg   384 

Pectoralis   Major    312 

Quadratus  Lumborum 314 

Quadriceps    Extensor    380 

Recti  Laterales  167 

Bectus  Capitis  Anticus  Minor.  171 

Rhomboids    311 

Scaleni    360 

Serratus  Magnus    312 

Splenius  Capitis  et  Colli 

220,  322,  361 

Sterno-cleido-mastoid     360 

Sterno-thyroid     365 

Sterno-hyoid     365 

Trapezius    220,  309,  359 

Myelitis     260 


X 


Xeck,  Examination   of 303 

Xerve  tissue   49,  51 

Acceleration   and   inhibition.  .  .279 

Central  nervous   system 56 

Conductivity    53 

Control    107 

Double  conduction   55 

Efferent    fibers    60 

Irritability    60 

Mechanical    stimulation    of....  54 

Xerve    bundles    55 

Reflex    action    58 

Secretory  nerves   106,  109 

Sensory     84 

Sympathetic  ganglia    .  61 

Trophicity    53 

Unity   of    54,   114 

Xerves,    Circumflex    140 

Fifth  cranial    389 

Fifth    intercostal    141 

First  four  cervical 213 


Page. 
Hypoglossal     ................  216 

Of   Wrisberg    ................  224 

Phrenic     ....................  219 

Pneumogastric    ...........  "5,  214 

Pudic     ......................  254 

Sciatic    .....................  383 

Spinal  accessory  .............  215 

Xervous  System— 

Cerebro-Spinal     ..............  11 

Communicating  fibers   ........  115 

9-^Q 

Functions   of    ............... 

Sympathetic     ................  11* 

Gray    Rami-comnumicantes.  .  .  .11 

Independence    of  ........  114> 

Lateral  Ganglia    .............  11^ 

Origin    ...................... 

Pre  vertebral  Plexuses   ........  li«> 

Visceral    Ganglia  .............  n 

Xeuralgia,    Cervico-brachial  .....  222 

...93 
Neuritis     .............. 

O 
Occipito-atlantal   articulation.  .  .  -1C 

Osmosis     ...................... 

Osteopathic  centers   ............  -1 

Osteopathy,    Definition  ...........  19 

04.     4-1 
Diagnosis    ................         *' 

Founder    of    ................. 

Formation    of   name    ..........  -6 

Growth   of    ...................  I 

Its  scope 

Mechanical  principles 
Therapeutics 
Yiew  of  pathology 
Ovaries,    Center 


w_ 
•~ 


-5 


...113 

Pain     

jf  °46 

Language   ot    

Palpation 

Of  the  ribs    29'J 

Of  the  spine 294 

Paraplegia    251 

Parturition   center    .  ...251 


INDEX. 


Page. 

Passive  movements  vs.  rest 289 

Pathology.  .90,  110,  174,  246,258,282 

Pectoralis   major    312 

Pelvic  viscera   133 

Perspiration    109,   112,   276 

Phrenic  nerve   219 

Physiology    106 

Pia   mater    119 

Pilocarpin     107 

Plexuses,  Brachial 115,  220 

Cardio  Pulmonary.  .  .115,  122,  128 

Carotid    119 

Cervical     217 

Hypogastric     133 

Lumbar     253 

Pelvic    115,    133 

Pharyngeal    115 

Prevertebral     115 

Sacral    253 

Solar    115,    131 

Subsidiary    133 

Pneumogastrie  Nerve    

75,   132,   214,  231 

Poison     107 

Popliteal   Space    386 

Portal  System,  Vaso-motor  Nerves 

89 

Pott's  Disease    217,  339 

Power  of  Encysting    277 

Predisposition     31 

Primary  Subluxationa 182 

Principles,  How  to  apply 329 

Prostate  Gland,  Examination  of. 303 

Pudic  Nerve 254 

Pulmonary  Plexus   129 

Q 

Quadratus  Lumborum    314 

R 

Kami     CoTiimunicantes,     White 
Formation,     Distribution 
and  Function   116 


Page. 
Gray,  Formation,  Distribution 

and   Function    117 

Efferentes    122 

Rectum,  Center    251 

Examination    of 303 

Eeflex  Action   58,  60 

Intensity    of 218 

Patellar    Tendon    63 

Eegion,  Interscapular   225 

Eenal    Center    126 

Resistance,    Arterial    73 

Cell   30,  265 

Bespiration,  Nervous  control   of.  188 

Pulmonary     133 

Rest 142,  289 

Eheumatism     98 

Ehomboids    311 

Ribs,  Elevation  or  depression  of. 302 

Eleventh   and   Twelfth 190 

Examination  of   186,  303 

First   189,  350 

Subluxation   of .  188,   343 

Tenth     190 

Rotation,    Cervical     36? 

Dorsal    329 

S 

Sacral   Ganglia    127 

Plexus    253,   256 

Saphenous  Opening    385 

Scaleni     360 

Scapula,  Subluxation  of   224 

Sciatic  nerve    136,  383 

Sebaceous  glands   107 

Secretion,  Cutaneous    109,   112 

Digestive    133 

Inhibition  of   279 

Renal     112 

Secretory  tissue   100,  107 

Innervation  of 100 

Segmentation    of    the    Nervous 

System     56 

Semilunar  ganglia    131 

Sensation,   Conscious   144 


INDEX. 


Page. 

Sensory  nerves    84 

Epithelium     102 

Serratus  Magnus    312 

Sexual  cells    104 

Sialagogues    107 

Skin,  Compensation   276 

Solar   plexus    131 

Specific  causes  of  disease 264 

Treatment     269 

Sphincter  vaginae    254 

Sphygmograms     248 

Spinal  accessory  nerve 21.1.   210 

Spinal   column,   Curvature 274 

Palpation   of    294 

Spine   depressed    337 

Spinous      processes,   Approxima- 
tion   of    182 

Separation    of    181 

Splanchnic  area   96,  236 

Great    125,    131 

Lesser    125 

Least    125 

Spleen,    Yaso-motor    center.  . .  . 

89,  132,  237.  240 

Splenius  Capitis  et  Colli.  . .  .322,  361 

Sterno-cleido-mastoid     360 

Sterno-hyoid     365 

Sterno-thyroid  muscle    365 

Stimuli.  Direct  and  indirect ..  .45,  46 

Excessive    30,    31 

Normal    29,    111 

Of  muscle 45 

Strength   of    280 

Stimulation  of  the  heart    77 

Structural  defects   31,  107 

Structure  vs.  Function 2S6 

Stomach,  Center 132,  233 

Hvperaemia  of    91 

Subluxations  .  .  .33,  35,  100,  108,  165 

Cause  of   168 

Clavicles    359 

Costal     188 

Definition     165 

Diagnosis    165 

Lateral 179.  183,  331,  337 


Page. 
Primary  and  secondary 182,  183 

Seduction   of    176,  331 

Bibs     343 

Suboccipital  triangles 95,  217 

Fossae,   Inhibition   in 390 

Superior   cervical   ganglion.... 

118,  173.  216 

Sympathetic  Nervous  System.  .  .  .114 

Symptomatology     2.'ii 

Symptoms   31,  32,  61 

Subjective    306 

T 

Tension,   Test  Muscular    300 

Testes,  Center ' i_'oi  i 

Therapeutics,   Osteopathic    .... 

25,  32,  94,  110,  111 

Hilton 's  Law    13" 

Thoracic   Ganglia    122 

Thorax,    The    276 

Flexibility    300 

Throat,    Vaso-motor    Center 88 

Thyroid    Ganglion    120 

Gland     88 

Tissues,  Structural  and  Contrac- 
tile     36,    37,    45 

Circulatory     40 

Displacement  by  violence    41 

Displacement      by     muscular 

contraction    43,  47 

Elastic     38 

Irritable    39,    49 

Metabolic    39,   100 

Nerve     51 

Tongue    88 

Tonics    107 

Tonsils     88 

Touch,  The  sense  of 290 

Trapezius   Muscle 309,   359 

Treatment  of     Abdominal  Vis- 
cera     132 

Of  Kyphosis    316 

Neck    359 

Heart     130 

Eational  ..283 


INDEX. 


Page. 

Specific    269 

Triangles,    Suboccipital    217 

Trophieity    53 

U 

Upper  Extremities,  Vaso-motor 

Centers    89 

Uterus,  Center   248,  251 


Vaso-constriction     81,    84 

Dilation    83,  84 

Centers,  head,  eyes,  tonsils. 88,  220 

Centers,  How  they  act 281 

Chief   center    80 

Subsidiary  centers   80 

Control   of   coronary   arteries 

78 

Nerves 79 

Nerves,  Manipulation  of 386 

Secretion     .  .  .  '. .  .108 


Page. 

Vertebrae,  Atlas  95,  304 

Third  Cervical  304 

Sixth  Cervical.  .140,  156,  305,  369 

Seventh  Cervical  140 

First  Dorsal  112,  125 

Sixth  Dorsal  132 

Seventh  Dorsal 112,  125 

Eighth  Dorsal  184 

Ninth  Dorsal  184 

Tenth  Dorsal  184 

Eleventh  Dorsal  132,  184 

Twelfth  Dorsal 126,  184 

Second  Lumbar  251 

Viscera,  Abdominal  132 

Pelvic  133 

Sensibility  of  143 

Thoracic  130 

Vital  Force,  Obstruction  to.... 42 


W 


Wrisberg,  Nerve  of 224 


Date  Due 


OCT 


11986 


<**r 


CAT.    NO.    23    233  PRINTED    IN    U.S.A. 


T198p 

1905 
Tasker. 

Principles  of  osteopathy 


UCI  CCM  LIBRARY 


